Tachykardien bei pulmonalarterieller Hypertonie

Bandorski, Dirk; Bogossian, Harilaos; Ghofrani, Ardeschir; Schmitt, J; Höltgen, Reinhard

doi:10.1007/s00399-020-00668-w

Cited by 5 publications

(3 citation statements)

References 38 publications

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“…In contrast to other studies, only few patients ( n = 4/65, 6.15%) had supraventricular tachycardia (AFib). In other studies, the incidence of supraventricular tachycardia has varied between 11.7% and 46.4% over a follow-up interval of 6–13 years ( 31 ). These results are in accordance with findings in two recent studies (12/43 and 162/641 patients) ( 32 , 33 ).…”

Section: Discussionmentioning

confidence: 93%

Incidence and prognostic significance of malignant arrhythmias during (repetitive) Holter electrocardiograms in patients with pulmonary hypertension

Bandorski

Heibel

Höltgen³

et al. 2023

Front. Cardiovasc. Med.

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BackgroundIn patients with pulmonary hypertension (PH), increased pulmonary vascular resistance (PVR) may lead to increased right ventricular afterload and cardiac remodelling, potentially providing the substrate for ventricular arrhythmias. Studies dealing with long term monitoring of patients with PH are rare. The present study evaluated the incidence and the types of arrhythmias retrospectively recorded by Holter ECG in patients with newly detected PH during a long-term Holter ECG follow-up. Moreover, their impact on patient survival was evaluated.Patients and methodsMedical records were screened for demographic data, aetiology of PH, incidence of coronary heart disease, level of brain natriuretic peptide (BNP), results from Holter ECG monitoring, 6-minute walk test distance, echocardiographic data and hemodynamic data derived from right heart catheterization. Two subgroups were analyzed: 1. patients (n = 65) with PH (group 1 + 4) and derivation of at least 1 Holter ECG within 12 months from initial detection of PH and 2. patients (all PH etiologies, n = 59) with 3 follow-up Holter ECGs. The frequency and complexity of premature ventricular contractions (PVC) was classified into “lower” and “higher” (=non sustained ventricular tachycardia, nsVT) burden.ResultsHolter ECG revealed sinus rhythm (SR) in most of the patients (n = 60). Incidence of atrial fibrillation (AFib) was low (n = 4). Patients with premature atrial contractions (PAC) tend to have a shorter period of survival (p = 0.098), PVC were not correlated with significant survival differences. During follow-up PAC and PVC were common in all PH groups. Holter ECG revealed non sustained ventricular tachycardia in 19/59 patients [(32.2%); n = 6 during first Holter-ECG, n = 13 during second/third Holter-ECG]. In all patients suffering from nsVT during follow-up previous Holter ECG revealed multiform/repetitive PVC. PVC burden was not linked to differences in systolic pulmonary arterial pressure, right atrial pressure, brain natriuretic peptide and results of six-minute walk test.ConclusionPatients with PAC tend to have a shortened survival. None of the evaluated parameters (BNP, TAPSE, sPAP) was correlated with the development of arrhythmias. Patients with multiform/repetitive PVC seem to be at risk for ventricular arrhythmias.

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Section: Discussionmentioning

confidence: 93%

Incidence and prognostic significance of malignant arrhythmias during (repetitive) Holter electrocardiograms in patients with pulmonary hypertension

Bandorski

Heibel

Höltgen³

et al. 2023

Front. Cardiovasc. Med.

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“…Progression of such a thoracic deformity may persist in compressing the right ventricle, thus causing structural and hemodynamic consequences that can lead to sinus, atrial, or ventricular tachycardia [93,94]. Increased right atrial pressure and dilation can also lead to increased sympathetic tone [95]. As an aside, obstruction of airflow and loss of lung elasticity can lead to lung hyperinflation that compresses the heart and elevates intrathoracic pressure, which reduces venous return and thus right ventricular output in patients with COPD [96].…”

Section: Proposed Management Algorithm For Ppfementioning

confidence: 99%

Proposed Clinical Algorithm for Pleuroparenchymal Fibroelastosis (PPFE)

Yamakawa,

Oda,

Sugino

et al. 2024

JCM

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Pleuroparenchymal fibroelastosis (PPFE) is characterized by fibrosis involving the pleura and subpleural lung parenchyma, predominantly in the upper lobes. As PPFE appears to occur in patients with heterogeneous etiologies, the disease course is thus also heterogenous, with some patients showing rapid progression while others have slow progression. Therefore, it is very difficult to predict prognosis with PPFE. Needless to say, this problematic matter has influenced the treatment strategy of PPFE patients. In fact, until now no evidence has been shown for use in creating an appropriate management algorithm for PPFE. We speculate that “uncoordinated breathing” is the most important reason for dyspnea in PPFE patients. Because monitoring of physique and not just pulmonary function and radiological evaluation is also very important, particularly in PPFE patients, this review focused on the characteristics of PPFE through an overview of previous studies in this field, and we proposed an algorithm as precision medicine based on the current evidence. Multiple views by the pulmonologist are needed to standardize a clinical algorithm that is necessary to correctly assess PPFE patients under the premise of maintenance of physique by providing appropriate nutritional care and pulmonary rehabilitation.

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“…DCCV requires anaesthetic support, carries out a significant risk, and should be ordered before irreversible haemodynamic changes occur. There are no clear indications for prophylactic implantation of ICD in PAH patients [78]. Anticoagulation should be initiated in all patients accordingly to individual patterns.…”

Section: Arrhythmiasmentioning

confidence: 99%

Critical Care Management of Decompensated Right Heart Failure in Pulmonary Arterial Hypertension Patients – An Ongoing Approach

Ţilea

Varga

Georgescu

et al. 2021

The Journal of Critical Care Medicine

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Despite substantial advancements in diagnosis and specific medical therapy in pulmonary arterial hypertension patients’ management, this condition continues to represent a major cause of mortality worldwide. In pulmonary arterial hypertension, the continuous increase of pulmonary vascular resistance and rapid development of right heart failure determine a poor prognosis. Against targeted therapy, patients inexorable deteriorate over time. Pulmonary arterial hypertension patients with acute right heart failure who need intensive care unit admission present a complexity of the disease pathophysiology. Intensive care management challenges are multifaceted. Awareness of algorithms of right-sided heart failure monitoring in intensive care units, targeted pulmonary hypertension therapies, and recognition of precipitating factors, hemodynamic instability and progressive multisystem organ failure requires a multidisciplinary pulmonary hypertension team. This paper summarizes the management strategies of acute right-sided heart failure in pulmonary arterial hypertension adult cases based on recently available data.

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Tachykardien bei pulmonalarterieller Hypertonie

Cited by 5 publications

References 38 publications

Incidence and prognostic significance of malignant arrhythmias during (repetitive) Holter electrocardiograms in patients with pulmonary hypertension

Incidence and prognostic significance of malignant arrhythmias during (repetitive) Holter electrocardiograms in patients with pulmonary hypertension

Proposed Clinical Algorithm for Pleuroparenchymal Fibroelastosis (PPFE)

Critical Care Management of Decompensated Right Heart Failure in Pulmonary Arterial Hypertension Patients – An Ongoing Approach

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