Document Type : Review Article

Authors

1 University of Giessen and Marburg Lung Center (UGMLC), member of the German Center for Lung Research (DZL), Klinikstrasse 33, 35392 Giessen, Germany

2 Klinikum Westmünsterland, St. Agnes-Hospital Bocholt Rhede, Medical Clinic 1 – Cardiology/Electrophysiology, Barloer Weg 125, 46397 Bocholt, Germany

Abstract

Incidence and prognostic relevance of supraventricular arrhythmias were evaluated in nine studies. These studies investigated patients with different forms of pulmonary hypertension. Supraventricular arrhythmias were more often found in patients with group two pulmonary hypertension. Common findings in these patients were elevated right atrial pressure and diameters and reduced tricuspid annular plane systolic excursion (TAPSE). Elevations in other parameters like systolic pulmonary arterial pressure, mean pulmonary arterial pressure, and pulmonary vascular resistance (PVR) were inconsistent. Most of the patients with arrhythmias suffered symptoms and improved after sinus rhythm (SR) was restored. The prognostic relevance of non-sustained ventricular tachycardia was evaluated in only one study. Non-sustained ventricular tachycardia does not seem to be prognostically relevant. Extending Holter electrocardiogram (ECG) monitoring over 24 hours up to 72 hours raises the detection rate of arrhythmias. Ablation of arrhythmias, especially atrial flutter and atrioventricular node reentry tachycardia, is feasible and safe in these patients.

Keywords

  1. Opitz CF, Blindt R, Blumberg F, et al. Pulmonary hypertension: Hemodynamic evaluation. Updated Recommendations of the Cologne Consensus Conference 2011. Int J Cardiol. 2011;154 Suppl 1:S13-19. doi:10.1016/S0167-5273(11)70489-2.
  2. Farber HW, Loscalzo J. Pulmonary arterial hypertension. N Engl J Med. 2004;351(16):1655-1665. doi:10.1056/NEJMra035488.
  3. Abe K, Toba M, Alzoubi A, et al. Formation of plexiform lesions in experimental severe pulmonary arterial hypertension. Circulation. 2010;121(25):2747-2754. doi:10.1161/CIRCULATIONAHA.109.927681.
  4. Rubin LJ. Primary pulmonary hypertension. N Engl J Med. 1997;336(2):111-117. doi:10.1056/NEJM199701093360207.
  5. Lee JK, Kodama I, Honjo H, Anno T, Kamiya K, Toyama J. Stage-dependent changes in membrane currents in rats with monocrotaline-induced right ventricular hypertrophy. Am J Physiol. 1997;272(6 Pt 2):H2833-2842. doi:10.1152/ajpheart.1997.272.6.H2833.
  6. Umar S, Lee JH, de Lange E, et al. Spontaneous ventricular fibrillation in right ventricular failure secondary to chronic pulmonary hypertension. Circ Arrhythm Electrophysiol. 2012;5(1):181-190. doi:10.1161/CIRCEP.111.967265.
  7. Bandorski D, Bogossian H, Ecke A, et al. Evaluation of the prognostic value of electrocardiography parameters and heart rhythm in patients with pulmonary hypertension. Cardiol J. 2016;23(4):465-472. doi:10.5603/CJ.a2016.0044.
  8. Malaczynska-Rajpold K, Komosa A, Blaszyk K, et al. The Management of Supraventricular Tachyarrhythmias in Patients with Pulmonary Arterial Hypertension. Heart Lung Circ. 2016;25(5):442-450. doi:10.1016/j.hlc.2015.10.008.
  9. Cannillo M, Grosso Marra W, Gili S, et al. Supraventricular Arrhythmias in Patients With Pulmonary Arterial Hypertension. Am J Cardiol. 2015;116(12):1883-1889. doi:10.1016/j.amjcard.2015.09.039.
  10. Wen L, Sun ML, An P, et al. Frequency of supraventricular arrhythmias in patients with idiopathic pulmonary arterial hypertension. Am J Cardiol. 2014;114(9):1420-1425. doi:10.1016/j.amjcard.2014.07.079.
  11. Kanmanthareddy A, Reddy YM, Boolani H, et al. Incidence, predictors, and clinical course of atrial tachyarrhythmias in patients with pulmonary hypertension. J Interv Card Electrophysiol. 2014;41(1):9-14. doi:10.1007/s10840-014-9928-5.
  12. Olsson KM, Nickel NP, Tongers J, Hoeper MM. Atrial flutter and fibrillation in patients with pulmonary hypertension. Int J Cardiol. 2013;167(5):2300-2305. doi:10.1016/j.ijcard.2012.06.024.
  13. Rottlaender D, Motloch LJ, Schmidt D, et al. Clinical impact of atrial fibrillation in patients with pulmonary hypertension. PLoS One. 2012;7(3):e33902. doi:10.1371/journal.pone.0033902.
  14. Ruiz-Cano MJ, Gonzalez-Mansilla A, Escribano P, et al. Clinical implications of supraventricular arrhythmias in patients with severe pulmonary arterial hypertension. Int J Cardiol. 2011;146(1):105-106. doi:10.1016/j.ijcard.2010.09.065.
  15. Tongers J, Schwerdtfeger B, Klein G, et al. Incidence and clinical relevance of supraventricular tachyarrhythmias in pulmonary hypertension. Am Heart J. 2007;153(1):127-132. doi:10.1016/j.ahj.2006.09.008.
  16. Bandorski D, Bogossian H, Stempfl J, et al. Prognostic Relevance of Nonsustained Ventricular Tachycardia in Patients with Pulmonary Hypertension. Biomed Res Int. 2016;2016:1327265. doi:10.1155/2016/1327265.
  17. Bandorski D, Schmitt J, Kurzlechner C, et al. Electrophysiological studies in patients with pulmonary hypertension: a retrospective investigation. Biomed Res Int. 2014;2014:617565. doi:10.1155/2014/617565.
  18. Folino AF, Bobbo F, Schiraldi C, et al. Ventricular arrhythmias and autonomic profile in patients with primary pulmonary hypertension. Lung. 2003;181(6):321-328. doi:10.1007/s00408-003-1034-x.
  19. Sun PY, Jiang X, Gomberg-Maitland M, et al. Prolonged QRS duration: a new predictor of adverse outcome in idiopathic pulmonary arterial hypertension. Chest. 2012;141(2):374-380. doi:10.1378/chest.10-3331.
  20. Hong-liang Z, Qin L, Zhi-hong L, et al. Heart rate-corrected QT interval and QT dispersion in patients with pulmonary hypertension. Wien Klin Wochenschr. 2009;121(9-10):330- 333. doi:10.1007/s00508-009-1184-9.
  21. Rich JD, Thenappan T, Freed B, et al. QTc prolongation is associated with impaired right ventricular function and predicts mortality in pulmonary hypertension. Int J Cardiol. 2013;167(3):669-676. doi:10.1016/j.ijcard.2012.03.071.
  22. Camm AJ, Kirchhof P, Lip GY, et al. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J. 2010;31(19):2369-2429. doi:10.1093/eurheartj/ehq278.
  23. Casella M, Carbucicchio C, Russo E, et al. Electrical storm in systemic sclerosis: Inside the electroanatomic substrate. World J Cardiol. 2014;6(10):1127-1130. doi:10.4330/wjc.v6.i10.1127.
  24. Medi C, Kalman JM, Ling LH, et al. Atrial electrical and structural remodeling associated with longstanding pulmonary hypertension and right ventricular hypertrophy in humans. J Cardiovasc Electrophysiol. 2012;23(6):614-620. doi:10.1111/j.1540-8167.2011.02255.x.
  25. Showkathali R, Tayebjee MH, Grapsa J, et al. Right atrial flutter isthmus ablation is feasible and results in acute clinical improvement in patients with persistent atrial flutter and severe pulmonary arterial hypertension. Int J Cardiol. 2011;149(2):279-280. doi:10.1016/j.ijcard.2011.02.059.
  26. Bradfield J, Shapiro S, Finch W, et al. Catheter ablation of typical atrial flutter in severe pulmonary hypertension. J Cardiovasc Electrophysiol. 2012;23(11):1185-1190. doi:10.1111/j.1540-8167.2012.02387.x.
  27. Luesebrink U, Fischer D, Gezgin F, et al. Ablation of typical right atrial flutter in patients with pulmonary hypertension. Heart Lung Circ. 2012;21(11):695-699. doi:10.1016/j.hlc.2012.06.005.