Pulmonary Hypertension Patients with Heart Arrhythmias Face Worse Prognosis

The presence of atrial arrhythmias may help predict unfavorable prognosis in patients with pulmonary hypertension (PH), according to a study published in the Cardiology Journal. The study also showed that longer P-waves, a type of wave found in electrocardiographies (ECG), can predict shorter survival rates.

The work was developed by researchers at the University of Giessen, in Germany, and titled “Evaluation of the prognostic value of electrocardiography parameters and heart rhythm in patients with pulmonary hypertension.”

PH is characterized by increased blood pressure. The increase in pulmonary vascular resistance makes it harder for blood to flow from the heart to the lungs, and makes the heart work harder.  The right ventricle becomes most affected, but both the right ventricle and atrium may become dilated and exhibit vascular changes. Patients with PH have a high incidence of arrhythmias. Some ECG parameters, such as the P-wave duration, have shown to be higher in patients developing a type of atrial arrhythmia called atrial fibrillation.

For the study, researchers looked at the long-term incidence of arrhythmias in newly diagnosed PH patients and assessed whether arrhythmias or ECG parameters could have predictive value in the patients.

The study included 167 patients with distinct types of hypertension, including pulmonary arterial hypertension (PAH), connective tissue disease, PH associated with left heart disease, PH associated with lung disease, and chronic thromboembolic PH (CTEPH). Each patient was analyzed through ECG, right heart catheterization and a 6-minute walking test.

At the start, 137 patients had defective hearth rhythm and 30 patients had atrial fibrillation. During follow-up, 13 more patients developed atrial fibrillation. Results revealed that longer P-wave duration, but not other ECG parameters, was associated with shorter survival. In fact, patients with baseline defective hearth rhythm were found to have an average survival time of 79.4 months, whereas those with baseline atrial fibrillation had 64.4 months average survival time, and those with newly onset atrial fibrillation had 58.8 months.

The study concluded that developing atrial fibrillation, which is associated with longer P-wave duration, predicts shorter survival times. Researchers noted that because the association becomes more complicated with age, the findings are particularly important for younger PH patients.