Assessment of cardiac arrhythmias using long-term continuous monitoring in patients with pulmonary hypertension

• Published in: International journal of cardiology 2021-07, Vol.334, p.110-115
• Main Authors: Andersen, Mads Ørbæk, Diederichsen, Søren Zöga, Svendsen, Jesper Hastrup, Carlsen, Jørn
• Format: Article
• Language: English
• Subjects: Arrhythmias; Continuous long-term monitoring; Pulmonary hypertension; Supraventricular tachycardia; Survival in PH
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2021.03.047

Cardiac arrhythmias are considered a prominent phenomenon in patients with pulmonary hypertension (PH). Older studies reported that 8% to 35% of patients with PH had supraventricular tachycardia (SVT), associated with adverse outcomes. Still, these arrhythmias have only been investigated via short-term monitoring or limited electrocardiogram recordings. Patients without previous arrhythmias diagnosed with PH at a tertiary facility received an insertable cardiac monitor as part of a prospective cohort study. Baseline assessments included World Health Organization functional class, six-minute walk test, echocardiography, and cardiac magnetic resonance imaging. Thirty-four patients with PH were included. Twenty-four patients had pulmonary arterial hypertension (PAH) and 10 had chronic thromboembolic PH (CTEPH). During 46 patient-years of continuous monitoring (median: 594 (range: 334–654) days per patient), 70 arrhythmia episodes were recorded in 13 patients (38%), with a median of two (range: 1–3) episodes and an arrhythmic burden median of 1.6 (range: 0.1–228) minutes per patient. SVTs were the most common arrhythmias, with 16% of episodes being atrial fibrillation and 84% being other types of SVTs. Additionally, three patients experienced bradycardias, including one resulting in syncope and subsequent pacemaker implantation. None of the patients had sustained ventricular arrhythmias. Arrhythmias were seen in 38% of contemporary patients with PH during long-term continuous monitoring; however, the vast majority of episodes were short and self-limiting. Modern therapy may alleviate the development of arrhythmias in stable patients with PH. This study is the first study to deploy long-term continuous monitoring in patients with PH. •First study with long-term continuous cardiac monitoring in pulmonary hypertension.•Surprisingly low arrhythmic burden of 7.5 days in 46 patient-years.•The vast majority of episodes of arrhythmias were of short duration and self-limiting.•Supraventricular arrhythmia predominant with only 14% atrial fibrillation.•Modern therapy may alleviate arrhythmias in stable pulmonary hypertension patients.