The impact of atrial fibrillation and atrial tachycardias on the hemodynamic status of patients with pulmonary hypertension

Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Supported by Ministry of Health, Czech Republic – conceptual development of research organization (General University Hospital in Prague – VFN, 00064165) Introduction Atrial fibrillation and atrial tachycardias (AF/AT) have been reported as a common condition in patients with pulmonary hypertension (PH). The presence of arrhythmia in patients with PH leads to increased morbidity and mortality. The significance and possibilities of AF/AT treatment in patients with PH is still being discussed. The aim of this study is to evaluate the effect of acute heart rhythm change on hemodynamical parameters in PH patients with AF/AT being treated by catheter ablation. Methods We performed an analysis of hemodynamic parameters and their changes in relation to the present heart rhythm. The study group consisted of 11 PH patients with AF/AT (6 males, median age (IQR) 72 (53;76) years) and was compared with a control group of 9 patients with AF/AT without PH or other structural heart disease (5 males, 56 (49;62) years). The data was acquired during the catheter ablation procedure using a Swan-Ganz catheter. Results PH patients had higher mean pressures (median; IQR; mmHg) in the right ventricle (31 (24;32) vs. 23 (18;25), p<0.05) and in the pulmonary artery (36 (30;37) vs. 22 (19;25), p<0.05) compared to the control group. Other parameters were comparable. There was a significant decrease of the left atrial pressure in the presence of arrhythmia in the PH group compared to the left atrial pressure change in the control group (p<0.05). The changes of the remaining hemodynamic parameters did not differ significantly between the groups. There was no significant difference in cardiac output in sinus rhythm and AF/AT in both groups. The detailed results are presented in the table below. Conclusion The left atrial pressure in PH patients changes significantly according to the actual heart rhythm. The acute impact of AF/AT on the other hemodynamical parameters, including cardiac output, has not been proven.