Atrial Arrhythmias in Patients With Pulmonary Hypertension

Kyle O'Meara; Gregory Stone; Eric Buch; Adam Brownstein; Rajan Saggar; Richard Channick; Alexander E Sherman; Aron Bender

doi:10.1016/j.chest.2024.03.002

Atrial Arrhythmias in Patients With Pulmonary Hypertension

Chest. 2024 Mar 5:S0012-3692(24)00291-5. doi: 10.1016/j.chest.2024.03.002. Online ahead of print.

Authors

Kyle O'Meara¹, Gregory Stone², Eric Buch³, Adam Brownstein⁴, Rajan Saggar⁴, Richard Channick⁵, Alexander E Sherman⁴, Aron Bender³

Affiliations

¹ Department of Pulmonary & Critical Care Medicine, Cedars Sinai Medical Center, Los Angeles, CA.
² UCLA Department of Internal Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.
³ UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, CA.
⁴ Division of Pulmonary, Critical Care, Sleep Medicine, Clinical Immunology and Allergy, David Geffen School of Medicine at UCLA, Los Angeles, CA.
⁵ Division of Pulmonary, Critical Care, Sleep Medicine, Clinical Immunology and Allergy, David Geffen School of Medicine at UCLA, Los Angeles, CA. Electronic address: rchannick@mednet.ucla.edu.

PMID: 38453002
DOI: 10.1016/j.chest.2024.03.002

Abstract

Topic importance: Atrial arrhythmia (AA) are common in patients with pulmonary hypertension (PH) and contribute to morbidity and mortality. Given the growing PH population, understanding the pathophysiology, clinical impact, and management of AA in PH is important.

Review findings: AA occurs in PH with a 5-year incidence of 10% to 25%. AA confers a higher morbidity and mortality, and restoration of normal sinus rhythm improves survival and functionality. AA is thought to develop because of structural alterations of the right atrium caused by changes to the right ventricle (RV) due to elevated pulmonary artery pressures. AA can subsequently worsen RV function. Current guidelines do not provide comprehensive recommendations for the management of AA in PH. Robust evidence to favor a specific treatment approach is lacking. Although the role of medical rate or rhythm control, and the use of cardioversion and ablation, can be inferred from other populations, evidence is lacking in the PH population. Much remains to be determined regarding the optimal management strategy. We present here our institutional approach and discuss areas for future research.

Summary: This review highlights the epidemiology and pathophysiology of AA in patients with PH, describes the relationship between AA and RV dysfunction, and discusses current management practices. We outline our institutional approach and offer directions for future investigation.

Keywords: PAH; PH; atrial arrhythmia; atrial fibrillation; atrial flutter; pulmonary arterial hypertension; pulmonary hypertension; right ventricle; right ventricular dysfunction.

Publication types

Review