Abstract
PurposePatients with pulmonary hypertension (PH) frequently suffer from supraventricular tachycardias (SVT). The main purpose of our study was to identify the cumulative incidence of SVT in patients with different etiologies of PH. The secondary objective was to analyse the clinical impact of SVT.MethodsWe retrospectively studied the prevalence of SVT and the clinical outcome in 755 patients (41% males; 60 ± 15 years; mean follow-up 3.8 ± 2.8 years) with PH of different etiologies. The prevalence of SVT was analysed separately in isolated pre-capillary PH (Ipc-PH) and in patients with combined post- and pre-capillary PH (Cpc-PH).ResultsThe prevalence of SVT in the Ipc-PH group (n = 641) was 25% (n = 162). The most prevalent arrhythmias were atrial fibrillation followed by a typical atrial flutter (17% and 4.4% of all Icp-PH patients). An excessive prevalence of SVT was found in patients with pulmonary arterial hypertension associated with congenital heart disease (35%, p = 0.01). Out of the overall study population, Cpc-PH was present in 114 (15%) patients. Patients with Cpc-PH manifested a higher prevalence of SVT than subjects with Ipc-PH (58; 51% vs. 162; 25%; p <0.0001) and were more likely to have persistent or permanent atrial fibrillation (38; 29% vs. 61; 10%; p <0.0001). Parameters significantly associated with mortality in a multivariate analysis included age, male gender, functional exercise capacity and right atrial diameter (p < 0.05). Neither diagnosis of SVT nor type of arrhythmia predicted mortality.ConclusionsThe study detected a significant prevalence of SVT in the population of PH of different origins. Different spectrum and prevalence of arrhythmia might be expected in different etiologies of PH. Patients with an elevated post-capillary pressure showed a higher arrhythmia prevalence, predominantly due to an excessive number of atrial fibrillations. The diagnosis of SVT was not associated with mortality.
Highlights
Pulmonary hypertension (PH) develops in multiple clinical conditions
The most prevalent arrhythmias were atrial fibrillation followed by a typical atrial flutter (17% and 4.4% of all Icp-PH patients)
An excessive prevalence of Supraventricular tachycardias (SVT) was found in patients with pulmonary arterial hypertension associated with congenital heart disease (35%, p = 0.01)
Summary
Pulmonary hypertension (PH) develops in multiple clinical conditions. PH can be categorized according to clinical presentation, pathological findings and haemodynamic characteristics [1,2]. Various treatment strategies have been established which have improved haemodynamics, exercise capacity, and quality of life [1]. Despite those advances, the prognosis of PH is generally inauspicious. Supraventricular tachycardias (SVT), including atrial fibrillation (AF), have been reported as a common condition in patients with idiopathic pulmonary arterial hypertension (PAH) [3,4] (range of cumulative incidence 10–36%), including all types of PAH [4,5,6,7,8], Eisenmenger‘s syndrome [9] or inoperable chronic thromboembolic pulmonary hypertension (CTEPH) [4,5,7]. A strategy attempting sinus rhythm (SR) restoration in patients with idiopathic PH appears to improve the clinical outcome [3,5]
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