title: The Management of Supraventricular Tachyarrhythmias in Patients with Pulmonary Arterial Hypertension.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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%).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Poznan University of Medical Sciences, I(st) Department of Cardiology, Poznan, Poland. Electronic address: katarzyna.rajpold@gmail.com.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Małaczyńska-Rajpold
authors.affiliation: Poznan University of Medical Sciences, I(st) Department of Cardiology, Poznan, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Komosa
authors.affiliation: Poznan University of Medical Sciences, I(st) Department of Cardiology, Poznan, Poland.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Błaszyk
authors.affiliation: Poznan University of Medical Sciences, I(st) Department of Cardiology, Poznan, Poland.
authors.forename: Aleksander
authors.initials: A
authors.lastname: Araszkiewicz
authors.affiliation: Poznan University of Medical Sciences, I(st) Department of Cardiology, Poznan, Poland.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Janus
authors.affiliation: Poznan University of Medical Sciences, I(st) Department of Cardiology, Poznan, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Olasińska-Wiśniewska
authors.affiliation: Poznan University of Medical Sciences, I(st) Department of Cardiology, Poznan, Poland.
authors.forename: Stanisław
authors.initials: S
authors.lastname: Jankiewicz
authors.affiliation: Poznan University of Medical Sciences, I(st) Department of Cardiology, Poznan, Poland.
authors.forename: Maciej
authors.initials: M
authors.lastname: Mączyński
authors.affiliation: Poznan University of Medical Sciences, I(st) Department of Cardiology, Poznan, Poland.
authors.forename: Tatiana
authors.initials: T
authors.lastname: Mularek-Kubzdela
mesh_terms: D000328:Adult; D000359:Aftercare; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage*; D017115:Catheter Ablation / Q000379:methods*; D018572:Disease-Free Survival; D004554:Electric Countershock / Q000379:methods*; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D013617:Tachycardia, Supraventricular / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000628:therapy
chemical_list: D000889:Anti-Arrhythmia Agents
keywords: Arrhythmia substrate; Atrial fibrillation; Atrial flutter; Atrial tachycardia; Pulmonary arterial hypertension; Supraventricular arrhythmia