Abstract 13581: Heart Rhythm versus Heart Rate Control Strategy in Patients With Pre-Capillary Pulmonary Hypertension and Atrial Arrhythmias

Abstract

Introduction: Atrial tachyarrhythmias in patients with pre-capillary pulmonary hypertension are often poorly tolerated leading to increased morbidity and mortality. Sinus rhythm restoration seems to improve outcomes but a direct comparison between rate and rhythm control has not been investigated. We sought to determine any difference in effectiveness between the two strategies. Methods: We performed a retrospective study in 88 patients with pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension (CTEPH) and new-onset atrial flutter or fibrillation seen in our centre from 2005-2020. Patients were divided into 3 groups based on management strategy: rate control (n=20), rhythm control with medication only (n=24) and rhythm control with DC cardioversion (DCCV) and medication (n=44) (Table 1). Differences in WHO functional class and incremental shuttle walk test distance (ISWTD) at arrhythmia onset and after treatment were measured. Results: Sinus rhythm was successfully restored in 42/44 (95%) of patients treated with DCCV and medication compared to 13/24 (54%) treated with amiodarone only (p<0.001). Cardioverted patients reported a significant improvement in functional class compared to patients treated with rate control (p<0.001). A similar improvement in ISWTD (≥15%) was also reported (p=0.004) (Table 2). No serious complications were reported with either strategy. Conclusions: A rhythm control strategy including DCCV and medication is a safe and effective way to restore sinus rhythm in patients with PAH/CTEPH and atrial tachyarrhythmias. Restoration and maintenance of sinus rhythm led to an improvement in their functional status.