Pulmonary arterial hypertension and atrial arrhythmias: incidence, risk factors, and clinical impact

Abstract

Atrial arrhythmia (AA) occurrence in pulmonary arterial hypertension (PAH) may determine clinical deterioration and affect prognosis. In this study we assessed AA incidence in idiopathic (IPAH) and systemic sclerosis related PAH (SSc-PAH) and evaluated risk factors, management, and impact on mortality. We collected baseline data from consecutive IPAH or SSc-PAH patients prospectively enrolled in the Johns Hopkins Pulmonary Hypertension Registry between January 2000 and July 2016. During follow-up AA onset, treatment, and outcome were recorded. Among 317 patients (201 SSc-PAH, 116 IPAH), 42 developed AA (19 atrial fibrillation, 10 flutter-fibrillation, 9 atrial flutter, and 4 atrial ectopic tachycardia) with a 13.2% cumulative incidence. Most events were associated with hospitalization (90.5%). Electrical or pharmacological cardioversion was attempted in most cases. Patients with AA had higher right atrial pressure, pulmonary wedge pressure (P < 0.005), NT-proBNP (P < 0.05), and thyroid disease prevalence (P < 0.005). Higher mortality was observed in patients with AA, though not statistically significant (LogRank P = 0.323). Similar long-term mortality between IPAH with AA and SSc-PAH without AA was observed (LogRank P = 0.098). SSc-PAH with AA had the worst prognosis. In PAH patients AA occurrence is a matter of significant concern. Therapeutic strategies aimed at restoring sinus rhythm may represent an important goal.

Association between right atrial area measured by echocardiography and prognosis among pulmonary arterial hypertension: a systematic review and meta-analysis

“…42 43 Additionally, right atrial enlargement due to increase in right atrial pressure could be a predisposing factor for the development of atrial arrhythmias, thus affecting the risk of hospitalisation and likely the prognosis in PAH. 44 Currently, the algorithm of risk assessment of 2015 European Society of Cardiology(ESC)/European Respiratory Society(ERS) guidelines for the diagnosis and treatment of PH, 2 suggests only one echo parameter, namely RAA, for use in multimarker risk stratification approach in patients with PAH. However, the evidence level of RAA for predicting prognosis in patients with PAH is low, and most importantly, the prognostic utility was only recommended for idiopathic PAH.…”

Acute Respiratory Failure in Interstitial Lung Disease Complicated by Pulmonary Hypertension

“…Non-pharmacologic interventions for atrial arrhythmias include electrical cardioversion and catheter ablation. Electrical cardioversion has only been studied in a limited number of Group 1 PAH patients, with a failure rate of approximately 77% [100]. Radiofrequency catheter ablation (RFCA) has been demonstrated to be a successful option for PH patients with supraventricular tachycardia, but this has not been described in decompensated states.…”

Supraventrikulárna tachykardia v kontexte idiopatickej pľúcnej artériovej hypertenzie / Supraventricular tachycardia in idiopathic pulmonary arterial hypertension

“…Prevalencia SV tachyarytmií sa pohybuje v rozmedzí približne 10 až 27 % (6). V analýze prospektívneho registra 317 pacientov s idiopatickou PAH a PAH asociovanou so systémovou sklerózou bola ich päťročná incidencia 13,2 %, z toho bola u 19 pacientov fibrilácia predsiení, u 10 arytmia klasifikovaná ako fibriloflutter, u 9 flutter predsiení a u štyroch ektopická atriálna tachykardia (7). V inom súbore tvorila AVNRT približne 10 % z 31 epizód SV arytmií u 27 pacientov.…”

“…Prítomná bola tiež rozsiahla dilatácia pravej predsiene a pravej komory (tabuľka 2) a zvýšený tlak v pravej predsieni pri najbližšej prechádzajúcej katetrizácii (14 mmHg). K rozvoju SV arytmie pri PAH môžu predisponovať aj rôzne typy postihnutia štítnej žľazy (7). U našej pacientky bola funkcia štítnej žľazy opakovane normálna.…”