Key result
Reducing mPAP by ≥3 mmHg is linked to ~75% lower ventricular arrhythmia burden in HF.
Why the study?
The association between ventricular arrhythmia burden or defibrillator therapy and pulmonary artery pressure had not been characterized in an ambulatory setting.
Does a reduction in ambulatory pulmonary artery pressure reduce ventricular arrhythmia burden in heart failure patients with an implantable cardiac defibrillator?
Cohort (n=162)
Does a reduction in ambulatory pulmonary artery pressure reduce ventricular arrhythmia burden in heart failure patients with an implantable cardiac defibrillator?
Elevated ambulatory pulmonary artery pressure is associated with a higher burden of ventricular arrhythmias in heart failure patients, and reducing this pressure may decrease arrhythmia burden.
The association between ventricular arrhythmia (VA) burden or defibrillator therapy and pulmonary artery pressure (PAP) has not been characterized in an ambulatory setting; thus, we sought in the present research to determine the relationship between ambulatory PAP and VA burden. A retrospective cohort study involving patients with an implantable cardiac defibrillator and CardioMEMS™ PAP sensor (Abbott Laboratories, Chicago, IL, USA) both transmitting remotely into the Merlin.net™ patient care network (Abbott Laboratories, Chicago, IL, USA) was conducted. VA and therapy burden in the six months following sensor implant were stratified by the baseline mean PAP. Patients with PAPs of 25 mmHg to 35 mmHg and those with PAPs of 35 mmHg or more were compared with individuals with PAPs of less than 25 mmHg. The change in VA burden was reported using the averaged mean PAP reduction during the first three months. A total of 162 patients aged 69.4 years ± 10.9 years were included (74% male) with a baseline mean PAP of 36.2 mmHg ± 10.4 mmHg. Twenty patients with a baseline mean PAP of less than 25 mmHg had no VAs over six months. For 61 patients with a baseline mean PAP of between 25 mmHg and 35 mmHg, the annualized number of days with ventricular tachycardia (VT)/ventricular fibrillation (VF) was 1.65/patient-year (p < 0.001), with 8% of patients having VT/VF events. For 81 patients with a baseline mean PAP of 35 mmHg or more, 19% of patients had a VT/VF event and an annualized number of days with VT/VF events of 1.45/patient-year (p < 0.001). When analyzing the treatment effect, a reduction of 3 mmHg or more in mean PAP over three months reduced arrhythmia burden over the next three months as compared with in patients without such an improvement. In conclusion, it is indicated that VAs are associated with high PAPs, and a reduction in PAP may lead to a reduction in VAs in real-world ambulatory patients.
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Doshi et al. (2019) conducted a cohort in Heart Failure (n=162). Reduction in mean pulmonary artery pressure (≥3 mmHg) vs. No reduction or <3 mmHg reduction in mean PAP was evaluated on Ventricular arrhythmia burden (VT/VF event days/patient-year) between 3 and 6 months (IRR 0.25, 95% CI 0.16-0.37, p=0.035). A ≥3 mmHg reduction in mean pulmonary artery pressure over 3 months reduced ventricular arrhythmia burden over the subsequent 3 months (IRR 0.25) compared to no improvement in heart failure patients.
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