Pulmonary arterial hypertension and atrial arrhythmias: incidence, risk factors, and clinical impact

Valentina Mercurio, Grace Peloquin, Khalil I. Bourji, Nermin Diab, Takahiro Sato, Blessing Enobun, Traci Housten-Harris, Rachel L Damico, Todd Matthew Kolb, Stephen Mathai, Ryan J. Tedford, Carlo G. Tocchetti, Paul M Hassoun

Research output: Contribution to journalArticle

Abstract

Atrial arrhythmia (AA) occurrence in pulmonary arterial hypertension (PAH) may determine clinical deterioration and affect prognosis. In this study we assessed AA incidence in idiopathic (IPAH) and systemic sclerosis related PAH (SSc-PAH) and evaluated risk factors, management, and impact on mortality. We collected baseline data from consecutive IPAH or SSc-PAH patients prospectively enrolled in the Johns Hopkins Pulmonary Hypertension Registry between January 2000 and July 2016. During follow-up AA onset, treatment, and outcome were recorded. Among 317 patients (201 SSc-PAH, 116 IPAH), 42 developed AA (19 atrial fibrillation, 10 flutter-fibrillation, 9 atrial flutter, and 4 atrial ectopic tachycardia) with a 13.2% cumulative incidence. Most events were associated with hospitalization (90.5%). Electrical or pharmacological cardioversion was attempted in most cases. Patients with AA had higher right atrial pressure, pulmonary wedge pressure (P < 0.005), NT-proBNP (P < 0.05), and thyroid disease prevalence (P < 0.005). Higher mortality was observed in patients with AA, though not statistically significant (LogRank P = 0.323). Similar long-term mortality between IPAH with AA and SSc-PAH without AA was observed (LogRank P = 0.098). SSc-PAH with AA had the worst prognosis. In PAH patients AA occurrence is a matter of significant concern. Therapeutic strategies aimed at restoring sinus rhythm may represent an important goal.

Original languageEnglish (US)
JournalPulmonary Circulation
Volume8
Issue number2
DOIs
StatePublished - Apr 1 2018

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Keywords

  • atrial arrhythmias
  • pulmonary arterial hypertension
  • systemic sclerosis

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Mercurio, V., Peloquin, G., Bourji, K. I., Diab, N., Sato, T., Enobun, B., Housten-Harris, T., Damico, R. L., Kolb, T. M., Mathai, S., Tedford, R. J., Tocchetti, C. G., & Hassoun, P. M. (2018). Pulmonary arterial hypertension and atrial arrhythmias: incidence, risk factors, and clinical impact. Pulmonary Circulation, 8(2). https://doi.org/10.1177/2045894018769874