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Ventricular tachycardias in patients with pulmonary hypertension: an underestimated prevalence? A prospective clinical study

Ventrikuläre Tachykardien bei Patienten mit pulmonaler Hypertonie – Wird die Prävalenz unterschätzt? Eine prospektive klinische Studie

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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.

Objectives

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/m2, 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.

Zusammenfassung

Hintergrund

Etwa 30 % der Patienten mit einer pulmonal-arteriellen Hypertonie versterben am plötzlichen Herztod, wobei die genaueren Ursachen unklar sind. Maligne Herzrhythmusstörungen wurden bisher als selten beschrieben. Systematische Studien zum Langzeitmonitoring in diesem Patientenkollektiv existieren nicht.

Fragestellung

Die aktuelle Studie untersucht die Häufigkeit potenziell relevanter Arrhythmien bei Patienten mit pulmonaler Hypertonie (PH).

Methode

Patienten mit einer PH und ohne bekannte Arrhythmien wurden im Rahmen einer ambulanten Vorstellung in die Studie eingeschlossen. Bei allen Patienten wurde ein Langzeit-EKG über 72 h durchgeführt. Zusätzlich wurden klinische Daten, die 6-Minuten-Gehstrecke, Laborparameter und die Befunde der Echokardiographie ausgewertet.

Ergebnisse

In die Studie wurden 92 Patienten (NYHA III/IV: 65,2 %/5,4 %, PH-Gruppe 1: 35,9 %, Gruppe 3: 10,9 %, Gruppe 4: 28,3 %, Gruppe 5: 2,2 %) eingeschlossen. Relevante Arrhythmien wurden bei 17 Patienten festgestellt: nichtanhaltende ventrikuläre Tachykardie (n = 12), intermittierender AV-Block Grad 2 (n = 1), intermittierender AV-Block Grad 3 (n = 3) und Vorhofflattern (n = 1). Der echokardiographisch gemessene systolische pulmonal-arterielle Druck und die Diameter der rechten Herzhöhlen waren bei den Patienten mit relevanten Arrhythmien erhöht. Im Rechtsherzkatheter zeigten sich bei diesen Patienten erhöhte pulmonal-vaskuläre Widerstände (672 vs. 542 dyn · s · cm−5; p = 0,247) und ein niedrigerer kardialer Index (2,46 vs. 2,82 l/min/m2; p = 0,184).

Schlussfolgerung

Ventrikuläre Tachykardien (VT) finden sich bei PH-Patienten häufiger als bisher berichtet. Die prognostische Relevanz von nichtanhaltenden VTs bei diesen Patienten ist unklar. Aufgrund der hohen Rate des plötzlichen Herztods in diesem Kollektiv erscheint ein engmaschiges Monitoring, z. B. mittels Eventrekordern, zur Identifikation gefährdeter Patienten sinnvoll.

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Authors and Affiliations

  1. University of Giessen and Marburg Lung Center (UGMLC), Giessen, Germany

    Dirk Bandorski FESC/FACC, J. Grimminger,  W. Seeger,  H.A. Ghofrani &  H. Gall

  2. Medical Clinic 1, University Hospital Giessen and Marburg GmbH, Giessen, Germany

    D. Erkapic,  J. Stempfl,  J. Schmitt,  R. Chasan &  C.W. Hamm

  3. Medical Clinic I—Cardiology/Electrophysiology, St.-Agnes Hospital Bocholt, Bocholt, Germany

    R. Höltgen

  4. Centre for Pulmonary Hypertension at Thoraxclinic Heidelberg, Heidelberg, Germany

    E. Grünig

  5. Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany

    T. Neumann

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  1. Dirk Bandorski FESC/FACC
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Corresponding author

Correspondence to Dirk Bandorski FESC/FACC.

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Conflict of interest

D. Bandorski, D. Erkapic, J. Stempfl, R. Höltgen, E. Grünig, J. Schmitt, R. Chasan, J. Grimminger, T. Neumann, C.W. Hamm, W. Seeger, and H. Gall declare that there are no conflicts of interest.

H.A. Ghofrani—Board membership: Actelion, Bayer, Ergonex, GSK, Novartis, and Pfizer; Consultancy: Actelion, Bayer, Ergonex, Gilead, GSK, Merck, Novartis, and Pfizer; Payment for lectures including service on speakers bureaus: Actelion, Bayer, Ergonex, Gilead, GSK, Novartis, and Pfizer; Travel/accommodations/meeting expenses: Actelion, Bayer, Ergonex, GSK, Merck, Novartis, and Pfizer.

All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies.

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Bandorski, D., Erkapic, D., Stempfl, J. et al. Ventricular tachycardias in patients with pulmonary hypertension: an underestimated prevalence? A prospective clinical study. Herzschr Elektrophys 26, 155–162 (2015). https://doi.org/10.1007/s00399-015-0364-8

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  • DOI: https://doi.org/10.1007/s00399-015-0364-8

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