Abstract
Introduction: There are few data regarding the frequency, importance and management of atrial arrhythmias in pulmonary hypertension (PH).
Methods: A six-year retrospective analysis was conducted of >1000 newly diagnosed patients with PH.
Results: There were 264 pre-existing cases of atrial fibrillation (AF) including 29% pulmonary arterial hypertension (PAH), 53% PH due to left heart disease (PH-LHD), and 7% chronic thromboembolic PH (CTEPH). PAH and CTEPH were more common (45% and 24%) than PH-LHD (17%) as the underlying cause of PH in the 29 patients who had atrial flutter (flutter) diagnosed prior to PH diagnosis (p<0.05). 49 new diagnoses of flutter or AF were made at PH diagnosis (n=6) or during follow-up (n=43). ∼7% of all PAH patients developed an atrial arrhythmia. Baseline age, exercise capacity and pulmonary haemodynamics were not significantly different between the flutter and AF group but initial mixed venous oxygen saturations were lower in patients developing flutter (58% v 64%, p=0.02). Management including chemical or DC cardioversion and/or ablation therapy maintained 59% of patients in sinus rhythm (SR). Failure to maintain SR was not associated with prognosis (p=0.9). Survival was worse in patients developing flutter rather than AF (figure).
Conclusion: Atrial arrhythmias are common in PH. AF is more commonly associated with PH-LHD and developing flutter was associated with poorer survival. Further analysis of optimal management strategies is required.
- © 2011 ERS
