Clinical implications of supraventricular arrhythmias in patients with severe pulmonary arterial hypertension

Abstract

Arrhythmias are an increasingly common problem in patients withpulmonary arterial hypertension (PAH) due to the morphologicalchangesintherightcardiacchambersandthemodulationofautonomicactivity [1]. We evaluated the impact of supraventricular tachycardia(SVT)inpatientswithpulmonaryhypertensiontoassessthesafetyandefficacy of electrophysiology study (EPS).We performed a retrospective cohort study between 1995 and2008. 282 patients with PAH, included in the group I of Dana Point PAHclassification [2] were included. PAH was defined as a mean pulmonaryarterial pressure (PAP) N25 mm Hg at rest along with a pulmonarycapillary wedge pressure (PCWP) b15 mmHg. Medical records ofpatients that experienced an episode of SVT were reviewed. All patientswith suspected intraventricular reentrant tachycardia (INRT) underwentEPS with ablation of slow pathway. In patients with suspected commonflutter an EPS with cavotricuspid isthmus ablation was performed.The mean age was 47.3±14.3 years and 16 patients (60.6%) werewomen.6patients(26.1%)hadidiopathicPAH,7(30.4%)aconnectivetissue disease, 6 (26.1%) toxic oil syndrome and 4 (17.4%) Eisenmen-ger syndrome. Theaverageintervalbetweenthe diagnosisof PAH andthe onset of SVT was 60.3±55.9 months. The total number of SVTevents was 28. The type of arrhythmia distribution was: AF (n=12,42.8%),uncommonflutter(n=7,25%),commonflutter(n=5,17.8%)and INRT (n=4, 14.2%). AF and flutter occurred in older patients