CLINICAL IMPACT OF SUPRAVENTRICULAR TACHYCARDIAS IN PATIENTS WITH CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION

Objectives: Supraventricular tachycardias (SVT) are frequently observed in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Their prevalence and impact on prognosis of patients are not known.
Methods: We retrospectively studied the prevalence of SVT and survival in 286 patients with CTEPH (aged 62 ± 13 years; 163 males; 192 proximal obstruction). Pulmonary endarterectomy (PEA) was performed in 142 patients. Two subgroups of non-PEA and PEA-treated patients were analyzed.
Results: SVT was observed in 59 (21%) patients, including atrial fibrillation (n = 38), atrial flutter (n = 16), focal atrial tachycardia (n = 4) and AV nodal re-entrant tachycardia (n = 1). In addition, new arrhythmia occurred in 22 (15%) patients after PEA: atrial fibrillation (n=13), atrial flutter (n = 7) and focal atrial tachycardia (n = 2). Total of 59 (21%) patients died during mean follow-up of 36 ± 23 months, with mortality of 17% and 24% in PEA and non-PEA subgroups, respectively. In PEA subgroup, mortality was 17% and 11% (nonsignificant difference) in those with and without previously manifested SVT, respectively. In non-PEA subgroup, mortality was 40% and 20% (p<0.05) in those with and without previously manifested SVT, respectively. The presence of SVT did not influence the clinical outcome in PEA subgroup.
Conclusion: The prevalence of SVT in patients with CTEPH is high and predicts the mortality if PEA is not indicated.