The Management of Supraventricular Tachyarrhythmias in Patients with Pulmonary Arterial Hypertension

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• 作者：Katarzyna Małaczyńska-Rajpold ; MD ; ^{katarzyna.rajpold@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Anna Komosa ; MD ; PhD ; Krzysztof Błaszyk ; MD ; PhD ; Aleksander Araszkiewicz ; MD ; PhD ; Magdalena Janus ; MD ; PhD ; Anna Olasińska-Wiśniewska ; MD ; PhD ; Stanisław Jankiewicz ; MD ; PhD ; Maciej Mączyński ; MD ; Tatiana Mularek-Kubzdela ; MD ; PhD
• 关键词：Supraventricular arrhythmia ; Pulmonary arterial hypertension ; Atrial fibrillation ; Atrial flutter ; Atrial tachycardia ; Arrhythmia substrate
• 刊名：Heart, Lung and Circulation
• 出版年：2016
• 出版时间：May 2016
• 年：2016
• 卷：25
• 期：5
• 页码：442-450
• 全文大小：2462 K

文摘

Atrial remodelling in pulmonary arterial hypertension (PAH) may lead to higher incidence of supraventricular arrhythmias (SVA). The purpose of this study was to evaluate the efficiency and safety of various methods for treatment of SVA in this group.

Methods

This was a single centre study. Forty-eight patients (33 women and 15 men) aged 19-77 years (median 49 years) were enrolled. There were 30 patients with idiopathic PAH, 10 had PAH associated with connective tissue disease, and eight with congenital heart disease. A retrospective analysis was performed to estimate the prevalence and type of supraventricular arrhythmias, as well as efficiency and safety of treatment methods. Mean follow-up period was 28.8±17.7 months.

Results

Supraventricular arrhythmias occurred in 17 patients (35%) and appeared to be atrial fibrillation, flutter or tachycardia. Supraventricular arrhythmias coexisted with elevated mean right atrial pressure in 75%. Four patients had more than one type of SVA. A flutter-like macro-reentrant form of atrial tachycardia dependent on cavo-tricuspid isthmus was found in four cases. The treatment of SVA included typical methods: antiarrhythmic drugs, direct current cardioversion (DCC), and radiofrequency (RF) ablation. All of the therapeutic methods were effective in managing acute arrhythmia. Three patients required re-ablation. Overall mortality: 14 patients (29%) in the whole study group, including six in SVA group (35%) and eight without SVA (26%).

Conclusions

In patients with PAH DCC, pharmacological cardioversion and RF ablation can be applied safely and effectively. Flutter-like macro-reentrant atrial tachycardia dependent on cavo-tricuspid isthmus is observed in this group. It is more challenging, but possible, to successfully treat this arrhythmia with RF ablation.