The left atrial substrate plays a significant role in the development of complex atrial tachycardia in patients with precapillary pulmonary hypertension

Abstract

BackgroundAtrial fibrillation (AF) and related atrial tachyarrhythmias (AT), including type I atrial flutter (AFL) are frequently observed in patients with pulmonary hypertension (PH). Their relationship to hemodynamic changes, atrial size, and ventricular function are still not fully verified.MethodsWe retrospectively studied hemodynamic data, echocardiographic findings and arrhythmia incidence in 814 patients with invasively diagnosed precapillary PH (aged 59\u2009±\u200914\u2009years; 46% males). Patients with combined or post-capillary PH were excluded.ResultsAF / AT were identified in 225 (28%) of all the study population. Compared to the subgroup without arrhythmia, patients with AF / AT had elevated right atrial pressure (11\u2009±\u20095 vs. 9\u2009±\u20095\u2009mmHg), wedge pressure (11\u2009±\u20093 vs. 10\u2009±\u20093), a more enlarged right atrium (50\u2009±\u200912 vs. 47\u2009±\u200911\u2009mm) and an increased left atrial diameter in the parasternal long axis projection, p\xa0<\u2009\xa00.05 for all comparisons. In the multivariate model, the left atrial size, patient age, arterial hypertension, diabetes and type of PH were associated with AF / AT occurrence, p\xa0<\u2009\xa00.05. Patients with type I AFL were more frequently male (39 (80%) vs. 62 (42%)), were younger (61\u2009±\u200911 vs. 67\u2009±\u200910\u2009years), had increased pulmonary artery mean pressure (50\u2009±\u200912 vs. 45\u2009±\u200912\u2009mmHg), less advanced left atrial dilatation (38\u2009±\u200910 vs. 42\u2009±\u20097\u2009mm), and a more enlarged right atrium (56\u2009±\u200912 vs. 48\u2009±\u200911) as compared to subjects with AF or other AT, p\xa0<\u2009\xa00.05.ConclusionsThe evidence of elevated wedge pressure and the enlargement of the left atrium especially in patients with AF suggest a parallel involvement of the left atrial substrate in arrhythmia formation despite invasively confirmed evidence of purely isolated precapillary PH. Substantial differences were noticed between patients with type I AFL and the remaining patients with other arrhythmia types.