Assessment of cardiac arrhythmias using long-term continuous monitoring in patients with pulmonary hypertension. (1st July 2021)

• Record Type: Journal Article
• Authors: Andersen, Mads Ørbæk; Diederichsen, Søren Zöga; Svendsen, Jesper Hastrup; Carlsen, Jørn
• Is Part Of: International journal of cardiology. Volume 334(2021)
• Page Start: 110
• Page End: 115
• Publication Date: 2021-07-01
• Subjects: Pulmonary hypertension -- Arrhythmias -- Continuous long-term monitoring -- Survival in PH -- Supraventricular tachycardia; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2021.03.047
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Cardiac arrhythmias are considered a prominent phenomenon in patients with pulmonary hypertension (PH). Older studies reported that 8% to 35% of patients with PH had supraventricular tachycardia (SVT), associated with adverse outcomes. Still, these arrhythmias have only been investigated via short-term monitoring or limited electrocardiogram recordings. Methods: Patients without previous arrhythmias diagnosed with PH at a tertiary facility received an insertable cardiac monitor as part of a prospective cohort study. Baseline assessments included World Health Organization functional class, six-minute walk test, echocardiography, and cardiac magnetic resonance imaging. Results: Thirty-four patients with PH were included. Twenty-four patients had pulmonary arterial hypertension (PAH) and 10 had chronic thromboembolic PH (CTEPH). During 46 patient-years of continuous monitoring (median: 594 (range: 334–654) days per patient), 70 arrhythmia episodes were recorded in 13 patients (38%), with a median of two (range: 1–3) episodes and an arrhythmic burden median of 1.6 (range: 0.1–228) minutes per patient. SVTs were the most common arrhythmias, with 16% of episodes being atrial fibrillation and 84% being other types of SVTs. Additionally, three patients experienced bradycardias, including one resulting in syncope and subsequent pacemaker implantation. None of the patients had sustained ventricular arrhythmias. Conclusions: Arrhythmias were seen in 38% of contemporary patients with PH during long-term continuous monitoring; however, the vast majority of episodes were short and self-limiting. Modern therapy may alleviate the development of arrhythmias in stable patients with PH. This study is the first study to deploy long-term continuous monitoring in patients with PH. Highlights: First study with long-term continuous cardiac monitoring in pulmonary hypertension. Surprisingly low arrhythmic burden of 7.5 days in 46 patient-years. The vast majority of episodes of arrhythmias were of short duration and self-limiting. Supraventricular arrhythmia predominant with only 14% atrial fibrillation. Modern therapy may alleviate arrhythmias in stable pulmonary hypertension patients.