title: Ventricular tachycardias in patients with pulmonary hypertension: an underestimated prevalence? A prospective clinical study.
abstract: BACKGROUND
  Sudden cardiac death (SCD) accounts for approximately 30 % in patients with pulmonary arterial hypertension (PAH). The exact circumference for SCD in this patient population is still unclear. Malignant cardiac arrhythmias are reported to be rarely present. There are no systematic data concerning long-term electrocardiographic (ECG) recording in patients with PAH.
  
  
  OBJECTIVE
  We sought to investigate the rate of potentially relevant arrhythmias in patients with pulmonary hypertension (PH).
  
  
  METHODS
  Consecutive patients without diagnosis of known cardiac arrhythmias followed in our outpatient clinic for PH were enrolled in the study. All patients underwent a 72-h Holter ECG. Clinical data, 6-min walk distance, laboratory values, and echocardiography were collected/performed.
  
  
  RESULTS
  Ninety-two consecutive patients (New York Heart Association class (NYHA) III/IV: 65.2 %/5.4 %, PH Group 1: 35.9 %, Group 3: 10.9 %, Group 4: 28.3 %, Group 5: 2.2 %) were investigated. Relevant arrhythmias were newly detected in 17 patients: non-sustained ventricular tachycardia (n = 12), intermittent second-degree heart block (n = 1), intermittent third-degree heart block (n= 3), and atrial flutter (n = 1). Echocardiographic systolic pulmonary pressure and diameter of the right heart were elevated in patients with relevant arrhythmias. Right heart catheterization revealed higher pulmonary vascular resistance (672 vs. 542 dyn · s · cm(-5), p = 0.247) and lower cardiac index (2.46 vs. 2.82 l/min/m(2), p = 0.184).
  
  
  CONCLUSIONS
  Ventricular tachycardias occur more often in PH patients than previously reported. However, the prognostic relevance of non-sustained ventricular tachycardias in this cohort remains unclear. As a large number of PH patients die from SCD, closer monitoring, e.g., using implantable event recorders, might be useful to identify patients at high risk.
authors.affiliation: University of Giessen and Marburg Lung Center (UGMLC), Giessen, Germany, dirk.bandorski@khw.med.uni-giessen.de.
authors.forename: Dirk
authors.initials: D
authors.lastname: Bandorski
authors.forename: D
authors.initials: D
authors.lastname: Erkapic
authors.forename: J
authors.initials: J
authors.lastname: Stempfl
authors.forename: R
authors.initials: R
authors.lastname: Höltgen
authors.forename: E
authors.initials: E
authors.lastname: Grünig
authors.forename: J
authors.initials: J
authors.lastname: Schmitt
authors.forename: R
authors.initials: R
authors.lastname: Chasan
authors.forename: J
authors.initials: J
authors.lastname: Grimminger
authors.forename: T
authors.initials: T
authors.lastname: Neumann
authors.forename: C W
authors.initials: CW
authors.lastname: Hamm
authors.forename: W
authors.initials: W
authors.lastname: Seeger
authors.forename: H A
authors.initials: HA
authors.lastname: Ghofrani
authors.forename: H
authors.initials: H
authors.lastname: Gall
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D058070:Asymptomatic Diseases; D015984:Causality; D015897:Comorbidity; D015716:Electrocardiography, Ambulatory / Q000706:statistics & numerical data*; D005188:False Negative Reactions; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D017678:Sex Distribution; D017180:Tachycardia, Ventricular / Q000175:diagnosis* / Q000453:epidemiology*; D055815:Young Adult