Radiofrequency Catheter Ablation of Supraventricular Tachycardia in Patients With Pulmonary Hypertension: Feasibility and Long-Term Outcome.

Bin Zhou,Yi-Zhou Jiang,Ying-Jie Qi,Feng-Yuan Yu,Ya-Zhe Ma,Si-Xian Weng,Zheng-Qin Zhai,Min Tang,Xin Gao,Xi-Qi Xu,Xin Jiang,Zhi-Cheng Jing,Yong-Jian Zhu

doi:10.3389/fphys.2021.674909

Abstract

BackgroundSupraventricular tachycardia (SVT) occurs commonly and is strongly correlated with clinical deterioration in patients with pulmonary hypertension (PH). This study aimed to investigate the feasibility and long-term outcome of radiofrequency catheter ablation (RFCA) in PH patients with SVT.Materials and MethodsConsecutive PH patients with SVT who were scheduled to undergo electrophysiological study and RFCA between September 2010 and July 2019 were included. The acute results and long-term success of RFCA were assessed after the procedure.ResultsIn total, 71 PH patients with 76 episodes of SVT were analyzed. Cavotricuspid isthmus-dependent atrial flutter (n = 33, 43.5%) was the most common SVT type, followed by atrioventricular nodal reentrant tachycardia (n = 16, 21.1%). Of the 71 patients, 60 (84.5%) underwent successful electrophysiological study and were subsequently treated by RFCA. Among them, acute sinus rhythm was restored in 54 (90.0%) patients, and procedure-related complications were observed in 4 (6.7%) patients. Univariate logistic regression analysis showed that cavotricuspid isthmus-independent atrial flutter [odds ratio (OR) 25.00, 95% confidence interval (CI) 3.45–180.98, p = 0.001] and wider pulmonary artery diameter (OR 1.19, 95% CI 1.03–1.38; p = 0.016) were associated with RFCA failure. During a median follow-up of 36 (range, 3–108) months, 7 patients with atrial flutter experienced recurrence, yielding a 78.3% 3-year success rate for RFCA treatment.ConclusionThe findings suggest that RFCA of SVT in PH patients is feasible and has a good long-term success rate. Cavotricuspid isthmus-independent atrial flutter and a wider PAD could increase the risk for ablation failure.

Highlights

Pulmonary hypertension (PH), a heterogeneous disease entity caused by various etiologies, is characterized by increased pulmonary vascular resistance and chronic right ventricular pressure overload (Simonneau et al, 2019)
The structural and electrical remodeling of the right atrium in PH patients could contribute to the development of supraventricular tachycardia (SVT) and the immediate decrease of cardiac output (Gaynor et al, 2005a)
Previous studies have demonstrated an approximate 20% incidence of SVT among PH patients, and SVT has been found to be independently associated with increased risks for clinical deterioration, hemodynamic instability, heart failure, and adverse prognosis (Tongers et al, 2007; Wen et al, 2014; Cannillo et al, 2015; Galiè et al, 2016; Middleton et al, 2019)

Summary

Introduction

Pulmonary hypertension (PH), a heterogeneous disease entity caused by various etiologies, is characterized by increased pulmonary vascular resistance and chronic right ventricular pressure overload (Simonneau et al, 2019). The right atrium is able to assist with filling of the right ventricle at low pressure and is responsible for up to 30% of normal right ventricular output by contraction (Gaynor et al, 2005b). The structural and electrical remodeling of the right atrium in PH patients could contribute to the development of supraventricular tachycardia (SVT) and the immediate decrease of cardiac output (Gaynor et al, 2005a). Supraventricular tachycardia (SVT) occurs commonly and is strongly correlated with clinical deterioration in patients with pulmonary hypertension (PH). This study aimed to investigate the feasibility and long-term outcome of radiofrequency catheter ablation (RFCA) in PH patients with SVT

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