Małaczyńska-Rajpold Katarzyna, Komosa Anna, Błaszyk Krzysztof, Araszkiewicz Aleksander, Janus Magdalena, Olasińska-Wiśniewska Anna, Jankiewicz Stanisław, Mączyński Maciej, Mularek-Kubzdela Tatiana
Poznan University of Medical Sciences, I(st) Department of Cardiology, Poznan, Poland.
Poznan University of Medical Sciences, I(st) Department of Cardiology, Poznan, Poland.
Heart Lung Circ. 2016 May;25(5):442-50. doi: 10.1016/j.hlc.2015.10.008. Epub 2015 Nov 2.
Atrial remodelling in pulmonary arterial hypertension (PAH) may lead to higher incidence of supraventricular arrhythmias (SVA). The purpose of this study was to evaluate the efficiency and safety of various methods for treatment of SVA in this group.
This was a single centre study. Forty-eight patients (33 women and 15 men) aged 19-77 years (median 49 years) were enrolled. There were 30 patients with idiopathic PAH, 10 had PAH associated with connective tissue disease, and eight with congenital heart disease. A retrospective analysis was performed to estimate the prevalence and type of supraventricular arrhythmias, as well as efficiency and safety of treatment methods. Mean follow-up period was 28.8±17.7 months.
Supraventricular arrhythmias occurred in 17 patients (35%) and appeared to be atrial fibrillation, flutter or tachycardia. Supraventricular arrhythmias coexisted with elevated mean right atrial pressure in 75%. Four patients had more than one type of SVA. A flutter-like macro-reentrant form of atrial tachycardia dependent on cavo-tricuspid isthmus was found in four cases. The treatment of SVA included typical methods: antiarrhythmic drugs, direct current cardioversion (DCC), and radiofrequency (RF) ablation. All of the therapeutic methods were effective in managing acute arrhythmia. Three patients required re-ablation. Overall mortality: 14 patients (29%) in the whole study group, including six in SVA group (35%) and eight without SVA (26%).
In patients with PAH DCC, pharmacological cardioversion and RF ablation can be applied safely and effectively. Flutter-like macro-reentrant atrial tachycardia dependent on cavo-tricuspid isthmus is observed in this group. It is more challenging, but possible, to successfully treat this arrhythmia with RF ablation.
肺动脉高压（PAH）患者的心房重构可能导致室上性心律失常（SVA）的发生率升高。本研究旨在评估该组患者中治疗SVA的各种方法的有效性和安全性。
这是一项单中心研究。纳入了48例年龄在19 - 77岁（中位年龄49岁）的患者（33例女性和15例男性）。其中30例为特发性PAH患者，10例PAH与结缔组织病相关，8例与先天性心脏病相关。进行回顾性分析以评估室上性心律失常的患病率和类型，以及治疗方法的有效性和安全性。平均随访期为28.8±17.7个月。
17例患者（35%）发生室上性心律失常，表现为心房颤动、扑动或心动过速。75%的室上性心律失常患者同时伴有平均右心房压力升高。4例患者有不止一种类型的SVA。4例患者发现了依赖于腔静脉 - 三尖瓣峡部的类似扑动的大折返性房性心动过速。SVA的治疗包括常用方法：抗心律失常药物、直流电复律（DCC）和射频（RF）消融。所有治疗方法在处理急性心律失常方面均有效。3例患者需要再次消融。总体死亡率：整个研究组中有14例患者（29%），包括SVA组中的6例（35%）和无SVA组中的8例（26%）。
在PAH患者中，DCC、药物复律和RF消融可以安全有效地应用。该组患者中观察到依赖于腔静脉 - 三尖瓣峡部的类似扑动的大折返性房性心动过速。用RF消融成功治疗这种心律失常更具挑战性，但也是可能的。
