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Herzrhythmusstörungen bei Patienten mit pulmonaler Hypertonie und Lungenerkrankungen

Arrhythmias in patients with pulmonary hypertension and chronic lung disease

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Zusammenfassung

Im Jahr 2018 wurde der Schwellenwert des mittleren pulmonalarteriellen Drucks für die Definition des Vorliegens einer pulmonalen Hypertonie (PH) geändert; demnach liegt die Prävalenz der PH nun bei etwa 1 % der globalen Bevölkerung. Eine wichtige Rolle bei der Entstehung von Arrhythmien bei PH-Patienten spielen die erhöhte Aktivität des sympathischen Nervensystems, elektrisches Remodeling und in dessen Folge eine relative Ischämie des rechten Vorhofs. Supraventrikuläre Arrhythmien wurden in einigen Studien hinsichtlich ihres Einflusses auf den Verlauf bei PH-Patienten untersucht, für ventrikuläre Arrhythmien ist die Datenlage unzureichend. Arrhythmien führen zu einer klinischen Verschlechterung, haben eine hohe Rezidivrate und treten im fortgeschrittenen Stadium der PH auf. Anhaltende Arrhythmien sind mit einer schlechten Prognose verbunden. Bei Tachykardien mit klar definierten Mechanismen (AV-Knoten-Reentry-Tachykardie [AVNRT] oder Vorhofflattern) sollte auch bei diesen Patienten primär eine Ablation erfolgen. Bei Patienten mit Vorhofflimmern sollte primär eine Rhythmuskontrolle (Kardioversion, Antiarrhythmika) durchgeführt werden. Die Therapie ventrikulärer Arrhythmien erfolgt individuell, eine prophylaktische Therapie sollte nicht erfolgen. In der Literatur finden sich wenige Daten zu Arrhythmien bei Patienten mit Lungenerkrankungen. Für Patienten mit chronisch obstruktiver Lungenerkrankung (COPD) gibt es eine gute Datenlage. COPD-Patienten haben häufig eine koronare Herzerkrankung, Vorhofflimmern und ventrikuläre Tachykardien. Betablocker haben eine große Bedeutung für COPD-Patienten, auch während einer Exazerbation. Interventionelle Therapien sind sicher möglich, wobei sich nicht selten arrhythmogene Foci außerhalb der Pulmonalvenen (im rechten Vorhof) finden.

Abstract

Pulmonary arterial hypertension (PAH) occurs in 1% of the global population and can be divided in different disease groups. Pathophysiological aspects leading to supraventricular arrhythmias in these patients are due to increased pulmonary and right atrial pressure, increased activity of the sympathetic nervous system leading to right atrial electrical remodeling and ischemia in the right atrium. In the clinical setting these patients present with atrial flutter, atrial fibrillation or with ectopic atrial tachycardia. Regarding ventricular tachycardia there is a lack of data. Occurrence of arrhythmia in these patients leads to a deterioration of PAH, so rhythm control should be the aim. This can be achieved by right atrial ablation, especially in patients presenting with atrial flutter; electric cardioversion or antiarrhythmic drug therapy are without definite guideline recommendations since there are too few clinical trials. Ablation with a transseptal approach in the left atrium is considered rather dangerous and should be avoided. Regarding arrhythmias in patients with chronic lung disease, few data are available. For patients with chronic obstructive pulmonary disease (COPD), there are good data available. These patients often suffer from coronary heart disease, atrial fibrillation, and ventricular tachycardia. Beta-blockers play an important role in COPD patients, even during exacerbation. Interventional therapies are safe but the arrhythmogenic foci often located outside of the pulmonary veins (in the right atrium).

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Literatur

  1. Al-Khatib SM, Stevenson WG, Ackerman MJ et al (2018) 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: executive summary: a report of the American college of cardiology/American heart association task force on clinical practice guidelines and the heart rhythm society. Heart Rhythm 15(10):e190–e252. https://doi.org/10.1016/j.hrthm.2017.10.035

    Article  PubMed  Google Scholar 

  2. Bandorski D, Bogossian H, Ecke A et al (2016) Evaluation of the prognostic value of electrocardiography parameters and heart rhythm in patients with pulmonary hypertension. Cardiol J 23(4):465–472. https://doi.org/10.5603/CJ.a2016.0044

    Article  PubMed  Google Scholar 

  3. Bandorski D, Bogossian H, Stempfl J et al (2016) Prognostic relevance of Nonsustained ventricular tachycardia in patients with pulmonary hypertension. Biomed Res Int 2016:1327265. https://doi.org/10.1155/2016/1327265

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Bandorski D, Erkapic D, Stempfl J et al (2015) Ventricular tachycardias in patients with pulmonary hypertension: an underestimated prevalence? A prospective clinical study. Herzschrittmachertherapie Elektrophysiologie 26(2):155–162. https://doi.org/10.1007/s00399-015-0364-8

    Article  PubMed  Google Scholar 

  5. Bandorski D, Schmitt J, Kurzlechner C et al (2014) Electrophysiological studies in patients with pulmonary hypertension: a retrospective investigation. Biomed Res Int 2014:617565. https://doi.org/10.1155/2014/617565

    Article  PubMed  PubMed Central  Google Scholar 

  6. Bogaard HJ, Abe K, Vonk Noordegraaf A et al (2009) The right ventricle under pressure: cellular and molecular mechanisms of right-heart failure in pulmonary hypertension. Chest 135(3):794–804. https://doi.org/10.1378/chest.08-0492

    Article  CAS  PubMed  Google Scholar 

  7. Bristow MR, Minobe W, Rasmussen R et al (1992) Beta-adrenergic neuroeffector abnormalities in the failing human heart are produced by local rather than systemic mechanisms. J Clin Invest 89(3):803–815. https://doi.org/10.1172/JCI115659

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Campo G, Pavasini R, Biscaglia S et al (2015) Overview of the pharmacological challenges facing physicians in the management of patients with concomitant cardiovascular disease and chronic obstructive pulmonary disease. Eur Heart Journal Cardiovasc Pharmacother 1(3):205–211. https://doi.org/10.1093/ehjcvp/pvv019

    Article  CAS  Google Scholar 

  9. Cannillo M, Grosso Marra W, Gili S et al (2015) Supraventricular arrhythmias in patients with pulmonary arterial hypertension. Am J Cardiol 116(12):1883–1889. https://doi.org/10.1016/j.amjcard.2015.09.039

    Article  PubMed  Google Scholar 

  10. Cirulis MM, Ryan JJ, Archer SL (2019) Pathophysiology, incidence, management, and consequences of cardiac arrhythmia in pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension. Pulm Circ 9(1):2045894019834890. https://doi.org/10.1177/2045894019834890

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Demerouti EA, Manginas AN, Athanassopoulos GD et al (2013) Complications leading to sudden cardiac death in pulmonary arterial hypertension. Respir Care 58(7):1246–1254. https://doi.org/10.4187/respcare.02252

    Article  PubMed  Google Scholar 

  12. Fauchier L, Babuty D, Melin A et al (2004) Heart rate variability in severe right or left heart failure: the role of pulmonary hypertension and resistances. Eur J Heart Fail 6(2):181–185. https://doi.org/10.1016/j.ejheart.2003.09.007

    Article  PubMed  Google Scholar 

  13. Folino AF, Bobbo F, Schiraldi C et al (2003) Ventricular arrhythmias and autonomic profile in patients with primary pulmonary hypertension. Am J Physiol 181(6):321–328. https://doi.org/10.1007/s00408-003-1034-x

    Article  CAS  Google Scholar 

  14. Galiè N, Humbert M, Vachiery J‑L et al (2016) 2015 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension: the joint task force for the diagnosis and treatment of pulmonary hypertension of the European society of cardiology (ESC) and the European respiratory society (ERS): endorsed by: association for European Paediatric and congenital cardiology (AEPC), international society for heart and lung transplantation (ISHLT). Eur Heart J 37(1):67–119. https://doi.org/10.1093/eurheartj/ehv317

    Article  Google Scholar 

  15. Galiè N, McLaughlin VV, Rubin LJ et al (2019) An overview of the 6th World Symposium on Pulmonary Hypertension. Eur Respir J. https://doi.org/10.1183/13993003.02148-2018

    Article  PubMed  PubMed Central  Google Scholar 

  16. Galiè N, Saia F, Palazzini M et al (2017) Left main coronary artery compression in patients with pulmonary arterial hypertension and angina. J Am Coll Cardiol 69(23):2808–2817. https://doi.org/10.1016/j.jacc.2017.03.597

    Article  PubMed  Google Scholar 

  17. Goudis CA (2017) Chronic obstructive pulmonary disease and atrial fibrillation: an unknown relationship. J Cardiol 69(5):699–705. https://doi.org/10.1016/j.jjcc.2016.12.013

    Article  PubMed  Google Scholar 

  18. Grünig E, Benjamin N, Krüger U et al (2018) General measures and supportive therapy for pulmonary arterial hypertension: Updated recommendations from the Cologne Consensus Conference 2018. Int J Cardiol 272:30–36. https://doi.org/10.1016/j.ijcard.2018.08.085

    Article  Google Scholar 

  19. Hardziyenka M, Surie S, de Groot JR et al (2011) Right ventricular pacing improves haemodynamics in right ventricular failure from pressure overload: an open observational proof-of-principle study in patients with chronic thromboembolic pulmonary hypertension. Europace 13(12):1753–1759. https://doi.org/10.1093/europace/eur189

    Article  PubMed  Google Scholar 

  20. Hoeper MM, Galié N, Murali S et al (2002) Outcome after cardiopulmonary resuscitation in patients with pulmonary arterial hypertension. Am J Respir Crit Care Med 165(3):341–344. https://doi.org/10.1164/ajrccm.165.3.200109-0130c

    Article  PubMed  Google Scholar 

  21. Hoeper MM, Ghofrani H‑A, Grünig E et al (2017) Pulmonary hypertension. Dtsch Arztebl Int 114(5):73–84. https://doi.org/10.3238/arztebl.2017.0073

    Article  PubMed  Google Scholar 

  22. Hoeper MM, Humbert M, Souza R et al (2016) A global view of pulmonary hypertension. Lancet Respir Med 4(4):306–322. https://doi.org/10.1016/S2213-2600(15)00543-3

    Article  Google Scholar 

  23. Hoeper MM, Huscher D, Pittrow D (2016) Incidence and prevalence of pulmonary arterial hypertension in Germany. Int J Cardiol 203:612–613. https://doi.org/10.1016/j.ijcard.2015.11.001

    Article  PubMed  Google Scholar 

  24. Kanmanthareddy A, Reddy YM, Boolani H et al (2014) Incidence, predictors, and clinical course of atrial tachyarrhythmias in patients with pulmonary hypertension. J Interv Card Electrophysiol 41(1):9–14. https://doi.org/10.1007/s10840-014-9928-5

    Article  PubMed  Google Scholar 

  25. Konecny T, Somers KR, Park JY et al (2018) Chronic obstructive pulmonary disease as a risk factor for ventricular arrhythmias independent of left ventricular function. Heart Rhythm 15(6):832–838. https://doi.org/10.1016/j.hrthm.2017.09.042

    Article  PubMed  Google Scholar 

  26. Latus H, Bandorski D, Rink F et al (2015) Heart rate variability is related to disease severity in children and young adults with pulmonary hypertension. Front Pediatr 3:63. https://doi.org/10.3389/fped.2015.00063

    Article  PubMed  PubMed Central  Google Scholar 

  27. Lee JC, Kim KC, Choe SY et al (2016) Reduced immunoreactivities of B‑type natriuretic peptide in pulmonary arterial hypertension rats after ranolazine treatment. Anat Cell Biol 49(1):7–14. https://doi.org/10.5115/acb.2016.49.1.7

    Article  PubMed  PubMed Central  Google Scholar 

  28. Luesebrink U, Fischer D, Gezgin F et al (2012) Ablation of typical right atrial flutter in patients with pulmonary hypertension. Heart Lung Circ 21(11):695–699. https://doi.org/10.1016/j.hlc.2012.06.005

    Article  PubMed  Google Scholar 

  29. Małaczyńska-Rajpold K, Komosa A, Błaszyk K et al (2016) The management of Supraventricular Tachyarrhythmias in patients with pulmonary arterial hypertension. Heart Lung Circ 25(5):442–450. https://doi.org/10.1016/j.hlc.2015.10.008

    Article  PubMed  Google Scholar 

  30. Mercurio V, Peloquin G, Bourji KI et al (2018) Pulmonary arterial hypertension and atrial arrhythmias: incidence, risk factors, and clinical impact. Pulm Circ 8(2):2045894018769874. https://doi.org/10.1177/2045894018769874

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Olsson KM, Halank M, Egenlauf B et al (2018) Decompensated right heart failure, intensive care and perioperative management in patients with pulmonary hypertension: updated recommendations from the cologne consensus conference 2018. Int J Cardiol 272:46–52. https://doi.org/10.1016/j.ijcard.2018.08.081

    Article  Google Scholar 

  32. Olsson KM, Nickel NP, Tongers J et al (2013) Atrial flutter and fibrillation in patients with pulmonary hypertension. Int J Cardiol 167(5):2300–2305. https://doi.org/10.1016/j.ijcard.2012.06.024

    Article  PubMed  Google Scholar 

  33. Piao L, Fang Y‑H, Cadete VJJ et al (2010) The inhibition of pyruvate dehydrogenase kinase improves impaired cardiac function and electrical remodeling in two models of right ventricular hypertrophy: resuscitating the hibernating right ventricle. J Mol Med 88(1):47–60. https://doi.org/10.1007/s00109-009-0524-6

    Article  CAS  PubMed  Google Scholar 

  34. Raymond RJ, Hinderliter AL, Willis PW et al (2002) Echocardiographic predictors of adverse outcomes in primary pulmonary hypertension. J Am Coll Cardiol 39(7):1214–1219. https://doi.org/10.1016/S0735-1097(02)01744-8

    Article  PubMed  Google Scholar 

  35. Roh S‑Y, Choi J‑I, Lee JY et al (2011) Catheter ablation of atrial fibrillation in patients with chronic lung disease. Circ Arrhythm Electrophysiol 4(6):815–822. https://doi.org/10.1161/CIRCEP.110.960435

    Article  PubMed  Google Scholar 

  36. Rottlaender D, Motloch LJ, Schmidt D et al (2012) Clinical impact of atrial fibrillation in patients with pulmonary hypertension. PLoS ONE 7(3):e33902. https://doi.org/10.1371/journal.pone.0033902

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Ruiz-Cano MJ, Gonzalez-Mansilla A, Escribano P et al (2011) Clinical implications of supraventricular arrhythmias in patients with severe pulmonary arterial hypertension. Int J Cardiol 146(1):105–106. https://doi.org/10.1016/j.ijcard.2010.09.065

    Article  PubMed  Google Scholar 

  38. Schrier RW, Bansal S (2008) Pulmonary hypertension, right ventricular failure, and kidney: different from left ventricular failure? Clin J Am Soc Nephrol 3(5):1232–1237. https://doi.org/10.2215/CJN.01960408

    Article  PubMed  PubMed Central  Google Scholar 

  39. Siontis KC, Geske JB, Gersh BJ (2015) Atrial fibrillation pathophysiology and prognosis: insights from cardiovascular imaging. Circ Cardiovasc Imaging. https://doi.org/10.1161/CIRCIMAGING.115.003020

    Article  PubMed  Google Scholar 

  40. Smith B, Genuardi MV, Koczo A et al (2018) Atrial arrhythmias are associated with increased mortality in pulmonary arterial hypertension. Pulm Circ 8(3):2045894018790316. https://doi.org/10.1177/2045894018790316

    Article  PubMed  PubMed Central  Google Scholar 

  41. Thomas CD, Dupree LH, DeLosSantos M et al (2019) Evaluation of the protective effects of β‑blockers in the management of acute exacerbations of chronic obstructive pulmonary disease. J Clin Pharm Ther 44(1):109–114. https://doi.org/10.1111/jcpt.12767

    Article  CAS  PubMed  Google Scholar 

  42. Tongers J, Schwerdtfeger B, Klein G et al (2007) Incidence and clinical relevance of supraventricular tachyarrhythmias in pulmonary hypertension. Am Heart J 153(1):127–132. https://doi.org/10.1016/j.ahj.2006.09.008

    Article  PubMed  Google Scholar 

  43. Torbicki A, Kurzyna M, Kuca P et al (2003) Detectable serum cardiac troponin T as a marker of poor prognosis among patients with chronic precapillary pulmonary hypertension. Circulation 108(7):844–848. https://doi.org/10.1161/01.CIR.0000084544.54513.E2

    Article  CAS  PubMed  Google Scholar 

  44. van Wolferen SA, Marcus JT, Westerhof N et al (2008) Right coronary artery flow impairment in patients with pulmonary hypertension. Eur Heart J 29(1):120–127. https://doi.org/10.1093/eurheartj/ehm567

    Article  PubMed  Google Scholar 

  45. Waligóra M, Tyrka A, Miszalski-Jamka T et al (2018) Right atrium enlargement predicts clinically significant supraventricular arrhythmia in patients with pulmonary arterial hypertension. Heart Lung 47(3):237–242. https://doi.org/10.1016/j.hrtlng.2018.01.004

    Article  PubMed  Google Scholar 

  46. Wen L, Sun M‑L, An P et al (2014) Frequency of supraventricular arrhythmias in patients with idiopathic pulmonary arterial hypertension. Am J Cardiol 114(9):1420–1425. https://doi.org/10.1016/j.amjcard.2014.07.079

    Article  PubMed  Google Scholar 

  47. Zipes DP, Camm AJ, Borggrefe M et al (2006) ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death—executive summary: a report of the American college of cardiology/American heart association task force and the European society of cardiology committee for practice guidelines (writing committee to develop guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death) developed in collaboration with the European heart rhythm association and the heart rhythm society. Eur Heart J 27(17):2099–2140. https://doi.org/10.1093/eurheartj/ehl199

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Medizinische Fakultät, Semmelweis Universität, Campus Hamburg, Lohmühlenstraße 5/Haus P, 20099, Hamburg, Deutschland

    Dirk Bandorski FACC, FESC, MHBA

  2. Intensivmedizin und internistische Diagnostik, Asklepios Neurologische Klinik Bad Salzhausen, Am Hasensprung 6, 63667, Nidda, Deutschland

    Dirk Bandorski FACC, FESC, MHBA

  3. Medizinische Klinik, Kardiologie/Elektrophysiologie, Klinikum Westmünsterland, St. Agnes-Hospital Bocholt Rhede, Barloer Weg 125, 46397, Bocholt, Deutschland

    Reinhard Höltgen

  4. Medizinische Klinik und Poliklinik II, Universitätsklinikum Gießen, Klinikstraße 33, 35392, Gießen, Deutschland

    Ardeschir Ghofrani

  5. Medizinische Klinik 1, Innere Medizin/Kardiologie, Universitätsklinikum Gießen, Klinikstraße 33, 35392, Gießen, Deutschland

    Viktoria Johnson &  Jörn Schmitt

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  1. Dirk Bandorski FACC, FESC, MHBA
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Correspondence to Dirk Bandorski FACC, FESC, MHBA.

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Interessenkonflikt

D. Bandorski, R. Höltgen, A. Ghofrani, V. Johnson und J. Schmitt geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Bandorski, D., Höltgen, R., Ghofrani, A. et al. Herzrhythmusstörungen bei Patienten mit pulmonaler Hypertonie und Lungenerkrankungen. Herzschr Elektrophys 30, 234–239 (2019). https://doi.org/10.1007/s00399-019-00637-y

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