Atrial flutter regression in HIV-associated pulmonary arterial hypertension after treatment with bosentan.
Pulmonary arterial hypertension (PAH) is a rare condition characterized by an increase in pulmonary arterial resistance leading to right heart failure and death. Arrhythmias are a growing problem in PAH; therefore, maintenance of sinus rhythm is considered to be an important treatment aim in these patients. We described the case of a 46-year-old woman with HIV-associated pulmonary arterial hypertension  who developed atrial flutter. After treatment with bosentan, it was observed a significant improvement in clinical and haemodynamic parameters. In addition, the AFL, which had previously persisted to both antiarrhythmic drug therapy and electrical stimulation, and had recurred after transthoracic electrical cardioversion, disappeared  in absence of any antiarrhythmic drug. Though the precise factors responsible for supraventricular arrhythmogenesis are still largely obscure, it is likely that initiation and maintenance of AFL may depend on all the conditions that can lead to increase in right atrial pressure, size, and wall stress, such as PAH. In our case, bosentan reduced both mean pulmonary artery pressure (mPAP) value and right heart chambers pressures. Therefore, it is conceivable that with the anatomical substrate needed for the maintenance of AFL being disappeared, sinus rhythm was restored.
San Camillo Clinic, Taranto. mariodmn84@hotmail.com.
Mario Francesco
MF
Damiani
Cristina
C
Scoditti
Elioda
E
Bega
Silvano
S
Dragonieri
Pierluigi
P
Carratù
Alfredo
A
Scoditti
Onofrio
O
Resta
D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001282:Atrial Flutter / Q000188:drug therapy* / Q000209:etiology; D000077300:Bosentan / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy* / Q000209:etiology; D008875:Middle Aged; D012074:Remission Induction; D016896:Treatment Outcome
D000959:Antihypertensive Agents; D000077300:Bosentan