Elsevier

American Heart Journal

Volume 153, Issue 1, January 2007, Pages 127-132
American Heart Journal

Clinical Investigation
Electrophysiology
Incidence and clinical relevance of supraventricular tachyarrhythmias in pulmonary hypertension

https://doi.org/10.1016/j.ahj.2006.09.008Get rights and content

Background

In patients with severe pulmonary hypertension (PH), right ventricular function is a main determinant of clinical stability and outcome. Supraventricular tachyarrhythmias (SVTs) may compromise cardiac function and threaten prognosis in patients with PH, but the incidence and clinical relevance of SVTs in PH and chronic right ventricular failure have not been evaluated.

Methods

In a 6-year retrospective single-center analysis, 231 consecutive patients followed for pulmonary arterial hypertension, or inoperable chronic thromboembolic PH were studied for SVTs. Analysis included incidence, clinical consequences, treatment, and outcome.

Results

Thirty-one episodes of SVT were observed in 27 of 231 patients (cumulative incidence 11.7%, annual risk 2.8% per patient), including atrial flutter (n = 15), atrial fibrillation (n = 13), and AV nodal reentry tachycardia (n = 3). Supraventricular tachyarrhythmia onset was almost invariably associated with marked clinical deterioration and right ventricular failure (84% of SVT episodes). Outcome was strongly associated with the type of SVT and restoration of sinus rhythm. During follow-up, cumulative mortality was low (6.3%, follow-up 26 ± 23 months) when sinus rhythm was restored (all cases of AV nodal reentry tachycardia and atrial flutter). In contrast, 9 of 11 patients with sustained atrial fibrillation died from right ventricular failure (cumulative mortality 82%, follow-up 11 ± 8 months).

Conclusions

In patients with PH, SVTs constitute a relevant problem, often resulting in clinical deterioration. Sustained atrial fibrillation may be associated with a high risk of death from right ventricular failure.

Section snippets

Patients

In this retrospective single-center study, files from 231 consecutive patients with PAH or inoperable CTEPH treated between 1998 and 2003 were analyzed for episodes of SVTs. All patients were regularly seen at 1 to 6 monthly intervals, or whenever clinically indicated, in the outpatient clinic for PH. Close physical examination and 12-channel electrocardiograms (ECGs) were obtained as part of the regular follow-up program during each individual visit. None of the patients was carrying any

Pulmonary hypertension population

A total number of 231 consecutive patients were included in this study. At the time of inclusion, all patients were in sinus rhythm, except for 2 patients with permanent atrial fibrillation (up to 5 years before the diagnosis of PH). The baseline characteristics of the entire population are shown in Table I.

Incidence of sustained SVT

Thirty-one episodes of sustained SVT were observed in 27 patients, resulting in a cumulative incidence of 11.7% and an annual risk of 2.8% per patient. The average interval between time of

Discussion

The clinical relevance of SVTs has not been systemically studied among patients with PH. The present study shows that SVTs pose a significant threat to this group of patients. In the present cohort of patients with PAH or inoperable CTEPH, the annual incidence of newly onset SVT was approximately 3%, with atrial fibrillation and atrial flutter being the most common types of SVT. The average interval between diagnosis of PH and onset of SVT was 3.5 years, suggesting that these arrhythmias are

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