Mechanisms and Advances in the Treatment of Arrhythmias Associated With Pulmonary Hypertension

Q: What is the clinical evidence from this study?

Study design: Review. Population: Pulmonary hypertension and associated arrhythmias. Intervention: PH-targeted therapy and antiarrhythmic treatments.

Q: What does this research mean for the field?

Arrhythmias associated with pulmonary hypertension arise from multifactorial electrical, structural, metabolic, and inflammatory remodeling, significantly increasing mortality risk, and require management through PH-targeted therapies, antiarrhythmics, and catheter ablation. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

Caijuan Huan; Zhaoming Fu; Rong Jiang; Shuo Liu; Xuan Zhang; Jian Yang

doi:10.31083/rcm52744

September 4, 2026Reviews in Cardiovascular MedicineOpen Access

Mechanisms and Advances in the Treatment of Arrhythmias Associated With Pulmonary Hypertension

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Key result

Treating PH-associated arrhythmias requires optimizing PH-targeted therapies, antiarrhythmic drugs, and catheter ablation.

Why the study?

Arrhythmias associated with pulmonary hypertension are major complications linked to increased mortality, with complex multifactorial pathophysiology requiring better understanding and treatment advances.

Key Points

To evaluate the pathophysiological mechanisms, diagnostic approaches, and established and emerging therapies for arrhythmias complicating pulmonary hypertension.
Synthesized preclinical and clinical literature concerning electrical, structural, metabolic, and inflammatory remodeling in pulmonary hypertension.
Assessed diagnostic modalities alongside established targeted drugs, catheter ablation, and emerging gene and microRNA therapies.
De novo atrial arrhythmias nearly quadruple the risk of death, yielding a 5-year survival rate of 47% compared to 68% in patients without atrial arrhythmias.
Atrial arrhythmias trigger clinical deterioration in 97.5% of pulmonary hypertension patients who rely heavily on atrial kick to preserve cardiac output.
Right ventricular electrical remodeling is marked by the downregulation of potassium channels (KV1.2, KV1.5, KV4.3), calcium channel CaV1.2, sodium channel NaV1.5, and connexin 43.

PICO

P

Population

Pulmonary hypertension and associated arrhythmias

I

Intervention / Comparator

PH-targeted therapy and antiarrhythmic treatments

This review highlights the multifaceted pathophysiological mechanisms underlying pulmonary hypertension-related arrhythmias and outlines current and emerging diagnostic and therapeutic strategies.

Limitations

Current evidence for miRNA regulation derives largely from animal models and lacks validation in humans
Paucity of research concerning the application of wearable devices for PH-related arrhythmias
Prognostic value of electrophysiological studies for ventricular arrhythmias remains uncertain

Implication

Emphasizes PH therapy optimization for arrhythmias in pulmonary hypertension; extends remodeling insights while leaving ablation and novel therapies open to prospective validation.

Abstract

Arrhythmias related to pulmonary hypertension (PH) are major complications of disease progression and are associated with a significantly increased risk of death. The pathophysiology of these arrhythmias involves complex, multifaceted mechanisms. Arrhythmic substrates include electrical remodeling (ion channel imbalance, gap junction protein connexin 43 (Cx43) dysfunction, and autonomic neuropathy), structural remodeling (right ventricular hypertrophy/fibrosis), metabolic disorders (mitochondrial dysfunction and the Warburg effect), and chronic inflammation. Clinically, PH-related atrial arrhythmias, particularly atrial fibrillation (AF)/flutter (AFL), are the most common. Diagnosis often requires combining ambulatory electrocardiography and implantable cardiac monitoring to detect subclinical events. Current treatment methods include optimizing PH-targeted therapy (e.g., dual- or triple-targeted drug therapy, soluble guanylate cyclase (sGC) stimulators), antiarrhythmic drugs, and catheter ablation, as well as emerging therapies such as Cx43 modulators, gene therapy (targeting bone morphogenetic protein receptor type 2 (BMPR2)/switch-independent 3A (SIN3A)), and microRNA (miRNA)-based regulation. Future work should focus on elucidating underlying mechanisms, developing precise risk stratification models, and formulating targeted individualized intervention strategies.

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Cite This Study

Huan et al. (2026) conducted a review in Pulmonary hypertension and associated arrhythmias. PH-targeted therapy and antiarrhythmic treatments was evaluated. Arrhythmias associated with pulmonary hypertension are primarily driven by electrical and structural remodeling, and their treatment relies on optimizing PH-targeted therapies, antiarrhythmic drugs, and catheter ablation.

synapsesocial.com/papers/6abda8ff4d657f10339f956d https://doi.org/10.31083/rcm52744