Clinical Impact of Atrial Fibrillation in Patients with Pulmonary Hypertension

Abstract

BackgroundPulmonary hypertension (PH) is associated with progressive impairment of right ventricular function, reduced exercise capacity and a poor prognosis. Little is known about the prevalence, clinical manifestation and impact of atrial fibrillation (AF) on cardiac function in PH.MethodsIn a four year single-centre retrospective analysis 225 patients with confirmed PH of various origins were enrolled to investigate the prevalence of AF, and to assess the clinical manifestation, 6-minute walk distance, NT-proBNP levels, echocardiographic parameters and hemodynamics obtained by right heart catheterization in PH with AF.ResultsAF was prevalent in 31.1%. In patients with PH and AF, parameters of clinical deterioration (NYHA/WHO functional class, 6-minute walk distance, NT-proBNP levels) and renal function were significantly compromised compared to patients with PH and sinus rhythm (SR). In the total PH cohort and in PH not related to left heart disease occurrence of AF was associated with an increase of right atrial pressure (RAP) and right atrial dilatation. While no direct association was found between pulmonary artery pressure (PAP) and AF in these patients, right ventricular function was reduced in AF, indicating more advanced disease. In PH due to left heart failure the prevalence of AF was particularly high (57.7% vs. 23.1% in other forms of PH). In this subgroup, left atrial dilatation, increase of pulmonary capillary wedge pressure, PAP and RAP were more pronounced in AF than in SR, suggesting that more marked backward failure led to AF in this setting.ConclusionPH is associated with increased prevalence of AF. Occurrence of AF in PH indicates clinical deterioration and more advanced disease.

Evaluation of the prognostic value of electrocardiography parameters and heart rhythm in patients with pulmonary hypertension

“…Further parameters known to be increased in patients with PH and arrhythmias are RAP and PVR [5,8,9]. Interestingly, in our study, RAP in patients who developed AF during follow-up (7 ± 5 vs. 5 ± 4 mm Hg) was lower than in other studies.…”

“…Mean survival time was shorter in patients with AF but this effect was not statistically significant. Rottlaender's et al study [8] revealed reduced TAPSE in patients with evidence of AF. These results are consistent with our study, which found reduced TAPSE in patients with AF in baseline ECG (15 ± 5 mm) compared with those with SR in the baseline ECG (18 ± 5 mm).…”

“…Five studies evaluated the incidence of atrial arrhythmias in patients with PH [5][6][7][8][9]. The cumulative incidence varied between 11.7% and 25.1% over periods of 6-13 years.…”

The relationship of arrhythmias with structural and functional heart changes according to the echocardiography data in the adult population of the Arctic

“…Частота ФП у пациентов с легочной гипертензи-ей составляет 31,1% (в 41,3% случаев пароксиз-мальная и в 58,7% случаев -постоянная форма ФП). Отмечена связь между ФП и дилатацией правых камер сердца [9,18,19]. В нашем исследовании получены ас-социации ЛГ с наджелудочковыми аритмиями и ЖЭ, а также установлены взаимосвязи между дилатацией ПП и ФП, между дилатацией ПЖ и ФП, а также ЖЭ.…”

Left Atrial Diameter and Survival among Renal Allograft Recipients

“…A study performed by Mielniczuk et al (22) showed that the consequence of higher right atrial pressure is reduced renal function. Another recently published study evaluated several echocardiographic parameters in a population with pulmonary hypertension (23). The group with the larger right atrial area suffered from significantly reduced renal function, although it has to be mentioned that this result might not be a causal relationship (23).…”