Supraventricular Arrhythmias in Patients With Pulmonary Arterial Hypertension

Published:October 03, 2015DOI:
      The onset of supraventricular arrhythmias (SVA) may be associated with clinical worsening in patients with pulmonary arterial hypertension (PAH). However, limited data have been reported, especially at long-term follow-up. Aim of this study was to investigate the incidence of SVA in our patients with PAH, the risk factors correlated to their onset and the prognostic impact. All consecutive patients with PAH without history of SVA were enrolled. Incidence of new SVA was investigated and also the risk factors for SVA. Primary end point of the study was the impact of SVA on a composite of all-cause mortality and re-hospitalization, whereas mortality was the secondary end point. Seventy-seven patients were enrolled. No significant differences in the clinical or instrumental baseline characteristics between the 2 study groups were reported. During a median follow-up of 35 months (interquartile range 21.5 to 53.5), 17 (22%) patients experienced SVA. Development of SVA was associated with worsening of prognostic parameters at the follow-up: increasing of World Health Organization (WHO) functional class (p = 0.005) and N-terminal-pro-brain natriuretic peptide (NT-proBNP) (p = 0.018) and reduction of 6-minute walking distance (p = 0.048), tricuspid annular plane systolic excursion (TAPSE) (p = 0.041), and diffusing capacity of the lung for carbon monoxide (p = 0.025). The primary end point occurred in 13 patients (76%) in the SVA group and in 22 patients (37%) in the group without SVA (p = 0.004), whereas 9 patients (53%) among those with SVA died during the follow-up compared with 8 (13%) among those without (p = 0.001). At multivariate analysis, development of SVA was independently associated with an increased risk to meet the both primary (hazard ratio 2.13; 95% confidence interval 1.07 to 4.34; p = 0.031) and secondary (hazard ratio 4.1; 95% confidence interval 1.6 to 10.6; p = 0.004) end points. In conclusion, during the 3-year follow-up period, 1/3 of patients with PAH developed SVA, which was related to worsening of hemodynamic and functional parameter and independently predicted adverse prognosis.
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        • Galiè N.
        • Hoeper M.M.
        • Humbert M.
        • Torbicki A.
        • Vachiery J.L.
        • Barbera J.A.
        • Beghetti M.
        • Corris P.
        • Gaine S.
        • Gibbs J.S.
        • Gomez-Sanchez M.A.
        • Jondeau G.
        • Klepetko W.
        • Opitz C.
        • Peacock A.
        • Rubin L.
        • Zellweger M.
        • Simonneau G.
        • ESC Committee for Practice Guidelines (CPG)
        Guidelines for the diagnosis and treatment of pulmonary hypertension: the Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the International Society of Heart and Lung Transplantation (ISHLT).
        Eur Heart J. 2009; 30: 2493-2537
        • Simonneau G.
        • Gatzoulis M.A.
        • Adatia I.
        • Celermajer D.
        • Denton C.
        • Ghofrani A.
        • Gomez Sanchez M.A.
        • Krishna Kumar R.
        • Landzberg M.
        • Machado R.F.
        • Olschewski H.
        • Robbins I.M.
        • Souza R.
        Updated clinical classification of pulmonary hypertension.
        J Am Coll Cardiol. 2013; 62: D34-D41
        • January C.T.
        • Wann L.S.
        • Alpert J.S.
        • Calkins H.
        • Cigarroa J.E.
        • Cleveland Jr., J.C.
        • Conti J.B.
        • Ellinor P.T.
        • Ezekowitz M.D.
        • Field M.E.
        • Murray K.T.
        • Sacco R.L.
        • Stevenson W.G.
        • Tchou P.J.
        • Tracy C.M.
        • Yancy C.W.
        • ACC/AHA Task Force Members
        2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society.
        Circulation. 2014; 130: 2071-2104
        • Blomström-Lundqvist C.
        • Scheinman M.M.
        • Aliot E.M.
        • Alpert J.S.
        • Calkins H.
        • Camm A.J.
        • Campbell W.B.
        • Haines D.E.
        • Kuck K.H.
        • Lerman B.B.
        • Miller D.D.
        • Shaeffer C.W.
        • Stevenson W.G.
        • Tomaselli G.F.
        • Antman E.M.
        • Smith Jr., S.C.
        • Alpert J.S.
        • Faxon D.P.
        • Fuster V.
        • Gibbons R.J.
        • Gregoratos G.
        • Hiratzka L.F.
        • Hunt S.A.
        • Jacobs A.K.
        • Russell Jr., R.O.
        • Priori S.G.
        • Blanc J.J.
        • Budaj A.
        • Burgos E.F.
        • Cowie M.
        • Deckers J.W.
        • Garcia M.A.
        • Klein W.W.
        • Lekakis J.
        • Lindahl B.
        • Mazzotta G.
        • Morais J.C.
        • Oto A.
        • Smiseth O.
        • Trappe H.J.
        • European Society of Cardiology Committee
        • NASPE-Heart Rhythm Society
        ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias-executive summary. A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for practice guidelines (writing committee to develop guidelines for the management of patients with supraventricular arrhythmias) developed in collaboration with NASPE-Heart Rhythm Society.
        J Am Coll Cardiol. 2003; 42: 1493-1531
        • Wen L.
        • Sun M.L.
        • An P.
        • Jiang X.
        • Sun K.
        • Zheng L.
        • Liu Q.Q.
        • Wang L.
        • Zhao Q.H.
        • He J.
        • Jing Z.C.
        Frequency of supraventricular arrhythmias in patients with idiopathic pulmonary arterial hypertension.
        Am J Cardiol. 2014; 114: 1420-1425
        • Tongers J.
        • Schwerdtfeger B.
        • Klein G.
        • Kempf T.
        • Schaefer A.
        • Knapp J.M.
        • Niehaus M.
        • Korte T.
        • Hoeper M.M.
        Incidence and clinical relevance of supraventricular tachyarrhythmias in pulmonary hypertension.
        Am Heart J. 2007; 153: 127-132
        • Ruiz-Cano M.J.
        • Gonzalez-Mansilla A.
        • Escribano P.
        • Delgado J.
        • Arribas F.
        • Torres J.
        • Flox A.
        • Riva M.
        • Gomez M.A.
        • Saenz C.
        Clinical implications of supraventricular arrhythmias in patients with severe pulmonary arterial hypertension.
        Int J Cardiol. 2011; 146: 105-106
        • Olsson K.M.
        • Nickel N.P.
        • Tongers J.
        • Hoeper M.M.
        Atrial flutter and fibrillation in patients with pulmonary hypertension.
        Int J Cardiol. 2013; 167: 2300-2305
        • Rajdev A.
        • Garan H.
        • Biviano A.
        Arrhythmias in pulmonary arterial hypertension.
        Prog Cardiovasc Dis. 2012; : 180-186
        • Medi C.
        • Kalman J.M.
        • Ling L.H.
        • Teh A.W.
        • Lee G.
        • Lee G.
        • Spence S.J.
        • Kaye D.M.
        • Kistler P.M.
        Atrial electrical and structural remodeling associated with longstanding pulmonary hypertension and right ventricular hypertrophy in humans.
        J Cardiovasc Electrophysiol. 2012; 23: 614-620
        • Anselmino M.
        • Matta M.
        • D'Ascenzo F.
        • Bunch T.J.
        • Schilling R.J.
        • Hunter R.J.
        • Pappone C.
        • Neumann T.
        • Noelker G.
        • Fiala M.
        • Bertaglia E.
        • Frontera A.
        • Duncan E.
        • Nalliah C.
        • Jais P.
        • Weerasooriya R.
        • Kalman J.M.
        • Gaita F.
        Catheter ablation of atrial fibrillation in patients with left ventricular systolic dysfunction: a systematic review and meta-analysis.
        Circ Arrhythm Electrophysiol. 2014; 7: 1011-1018
        • Handoko M.L.
        • de Man F.S.
        • Allaart C.P.
        • Paulus W.J.
        • Westerhof N.
        • Vonk-Noordegraaf A.
        Perspectives on novel therapeutic strategies for right heart failure in pulmonary arterial hypertension: lessons from the left heart.
        Eur Respir Rev. 2010; 19: 72-82