Arrhythmias in Patients With Pulmonary Hypertension; A Narrative Review of the Current Literature

Incidence and prognostic relevance of supraventricular arrhythmias were evaluated in nine studies. These studies investigated patients with different forms of pulmonary hypertension. Supraventricular arrhythmias were more often found in patients with group two pulmonary hypertension. Common findings in these patients were elevated right atrial pressure and diameters and reduced tricuspid annular plane systolic excursion (TAPSE). Elevations in other parameters like systolic pulmonary arterial pressure, mean pulmonary arterial pressure, and pulmonary vascular resistance (PVR) were inconsistent. Most of the patients with arrhythmias suffered symptoms and improved after sinus rhythm (SR) was restored. The prognostic relevance of non-sustained ventricular tachycardia was evaluated in only one study. Non-sustained ventricular tachycardia does not seem to be prognostically relevant. Extending Holter electrocardiogram (ECG) monitoring over 24 hours up to 72 hours raises the detection rate of arrhythmias. Ablation of arrhythmias, especially atrial flutter and atrioventricular node reentry tachycardia, is feasible and safe in these patients.