Abstract
The association between ventricular arrhythmia (VA) burden or defibrillator therapy and pulmonary artery pressure (PAP) has not been characterized in an ambulatory setting; thus, we sought in the present research to determine the relationship between ambulatory PAP and VA burden. A retrospective cohort study involving patients with an implantable cardiac defibrillator and CardioMEMS™ PAP sensor (Abbott Laboratories, Chicago, IL, USA) both transmitting remotely into the Merlin.net™ patient care network (Abbott Laboratories, Chicago, IL, USA) was conducted. VA and therapy burden in the six months following sensor implant were stratified by the baseline mean PAP. Patients with PAPs of 25 mmHg to 35 mmHg and those with PAPs of 35 mmHg or more were compared with individuals with PAPs of less than 25 mmHg. The change in VA burden was reported using the averaged mean PAP reduction during the first three months. A total of 162 patients aged 69.4 years ± 10.9 years were included (74% male) with a baseline mean PAP of 36.2 mmHg ± 10.4 mmHg. Twenty patients with a baseline mean PAP of less than 25 mmHg had no VAs over six months. For 61 patients with a baseline mean PAP of between 25 mmHg and 35 mmHg, the annualized number of days with ventricular tachycardia (VT)/ventricular fibrillation (VF) was 1.65/patient-year (p < 0.001), with 8% of patients having VT/VF events. For 81 patients with a baseline mean PAP of 35 mmHg or more, 19% of patients had a VT/VF event and an annualized number of days with VT/VF events of 1.45/patient-year (p < 0.001). When analyzing the treatment effect, a reduction of 3 mmHg or more in mean PAP over three months reduced arrhythmia burden over the next three months as compared with in patients without such an improvement. In conclusion, it is indicated that VAs are associated with high PAPs, and a reduction in PAP may lead to a reduction in VAs in real-world ambulatory patients.
Highlights
Ventricular arrhythmias (VAs) are highly prevalent in patients with advanced heart failure (HF).[1]
To study the relation between pulmonary artery pressure (PAP) and arrhythmia, we looked at the rates of all ventricular tachycardia (VT)/ventricular fibrillation (VF) events, antitachycardia pacing (ATP) events, and shocks in patients with baseline mean PAPs of less than 25 mmHg, 25 mmHg to 35 mmHg, and 35 mmHg or more, respectively
We identified 205 implantable cardioverter-d efibrillators (ICDs) implanted patients who were implanted with a PAP sensor between August 2014 and March 2016
Summary
Ventricular arrhythmias (VAs) are highly prevalent in patients with advanced heart failure (HF).[1] Elevated intracardiac pressures may provoke the onset of VAs. Acute ventricular dilatation in animal preparations have been shown to have arrhythmogenic effects.[2] The average daily median estimated pulmonary artery diastolic (ePAD) pressure has been shown to be associated with an increased risk for ventricular tachycardia (VT)/ventricular fibrillation (VF).[3] In the Reducing Decompensation. Association between Arrhythmia and PAP in HF Patients. Events Utilizing Intracardiac Pressures in Patients with Chronic HF (REDUCEhf) trial, the absolute value of the ePAD pressure measurement was not found to be associated with arrhythmic risk. There was no decrease in the primary endpoint of HF events,[4] perhaps due to an insufficient level of specificity in the measurement
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