2nd Department of Internal Medicine - Cardiovascular Medicine, 1st Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic.
Kardiol Pol. 2024;82(6):602-608. doi: 10.33963/v.phj.101246.
Supraventricular tachycardia (SVT) is a frequent complication of pulmonary hypertension (PH). The most prevalent SVTs are atrial fibrillation (AF) and typical atrial flutter (AFL), followed by focal and macroreentrant atrial tachycardia (AT) and nodal arrhythmia (AV nodal reentry tachycardia or AV reentry tachycardia). SVT is frequently associated with functional deterioration and right ventricular failure in PH patients. According to some data, reestablishing sinus rhythm is associated with clinical improvement. Catheter ablation of typical AFL, nodal tachyarrhythmias, or other less complex focal ATs have been shown to be feasible, acutely effective, and safe in patients with PH. However, the long-term clinical outcome is modified by the recurrence of index arrhythmia and the onset of a new SVT. Due to right atrial dilatation, technical issues can arise when ablation is carried out. The role of catheter ablation in patients with AF or more complex AT is even less effective. The results mirror the success rate in the general AF population with non-paroxysmal AF. However, the data is limited, and electrophysiological procedures are also more often complicated by specific adverse events in a severely frail population. Despite these limitations, catheter ablation is the treatment of choice in less complex SVT, but the indications for AF ablation must be more individualized.
室上性心动过速（SVT）是肺动脉高压（PH）的常见并发症。最常见的 SVTs 是心房颤动（AF）和典型的心房扑动（AFL），其次是局灶性和大折返性房性心动过速（AT）和结性心律失常（AV 结折返性心动过速或 AV 折返性心动过速）。SVT 常伴有 PH 患者的功能恶化和右心室衰竭。根据一些数据，恢复窦性心律与临床改善相关。导管消融典型的 AFL、结性心动过速或其他不太复杂的局灶性 AT 已被证明在 PH 患者中可行、急性有效且安全。然而，指数心律失常的复发和新 SVT 的出现会改变长期临床结果。由于右心房扩张，在进行消融时可能会出现技术问题。导管消融在 AF 或更复杂 AT 患者中的作用甚至更差。结果反映了非阵发性 AF 一般人群中消融的成功率。然而，数据有限，电生理程序在严重脆弱人群中也更容易出现特定的不良事件。尽管存在这些局限性，但导管消融仍然是治疗较简单的 SVT 的首选方法，但 AF 消融的适应证必须更加个体化。
