Cardiac arrhythmias pose risk in pulmonary hypertension patients

By Eleanor McDermid, Senior medwireNews Reporter

Supraventricular arrhythmias (SVAs) are common and usually cause clinical deterioration in patients with idiopathic pulmonary arterial hypertension (IPAH), a study shows.

Persistent SVAs were associated with an increased mortality risk, whereas successful treatment led to clinical recovery, the researchers report in the American Journal of Cardiology.

“These findings support that restoration and maintenance of sinus rhythm are important treatment goal[s] in IPAH patients”, write Zhi-Cheng Jing (Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing) and co-authors.

The prospective, multicentre study involved 280 IPAH patients, aged an average of 39 years, of whom 40 had at least one SVA during an average 31 months of follow-up, giving a 6-year cumulative incidence of 15.8%.

Survival was significantly poorer in patients who developed SVAs than those who did not, with 1-year rates of 85% versus 92% and 6-year rates of 53% versus 75%. However, the survival disadvantage was confined to patients with persistent arrhythmia, which increased mortality risk nearly fivefold after accounting for potential confounders. By contrast, the survival of patients with transient SVAs was not significantly different to that of those without arrhythmias.

The most common SVAs were atrial fibrillation, flutter and tachycardia. Treatment successfully restored sinus rhythm in all cases of atrial tachycardia, but less than half of atrial flutter cases and only a quarter of atrial fibrillation cases.

Jing et al note that most patients with SVAs had marked clinical deterioration or worsening heart failure, with the most common signs being increasing dyspnoea on exertion, palpitations and fluid retention with leg oedema. However, one patient was asymptomatic at the time of diagnosis.

Also, the researchers found that markers of heart enlargement (increased right ventricular diameter and left atrial area) significantly increased the likelihood of patients developing an SVA, as did increased mean right atrial pressure and pulmonary vascular resistance.

“Thus, electrocardiogram (even Holter monitor), echocardiography and right heart catheterization should be part of our routine assessment for PAH patients”, concludes the team.

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