Researchers from the UK found that restoration of sinus rhythm was associated with functional improvement and superior survival in patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). They suggested that electrical cardioversion (DCCV) could be an effective strategy to restore normal rhythm.

“DCCV is generally safe and more effective at restoring sinus rhythm than pharmacological therapy in this patient group,” they wrote in the International Journal of Cardiology.

The study cohort was composed of patients with atrial flutter (AFL, 71%) and atrial fibrillation (AF, 29%). Comparison between the 2 groups showed that patients with AFL were more likely to have rhythm conversion than patients with AF. In general, most patients (76%) with idiopathic PAH achieved the restoration of sinus rhythm (80% vs
54%).


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Patients who achieved sinus rhythm were more likely to have improved in functional class and in Incremental Shuttle Walk Distance at their follow-up visits than those who remained in the AFL/AF group. Moreover, they had a superior 3-year survival rate (62% vs 23%, respectively).

Almost half (46%) of the cardioverted patients experienced one or more recurrences of arrhythmia during the study period. The authors identified right atrial (RA) size as a predictor of arrhythmia recurrence.

Most patients (95%) exposed to DCCV had their normal rhythm restored, while the percentages of patients whose sinus rhythm was restored via rate control or medical rhythm control were 33% and 59%, respectively.

Patients in the rate control group received either digoxin (56%), digoxin and bisoprolol (22%), or a nondihydropyridine calcium channel blocker (6%). Three patients (17%) were not treated with rate-limiting medication. Patients in the medical rhythm control group received digoxin and amiodarone (50%), amiodarone (41%), or a CCB and amiodarone (9%). Most patients in the DCCV group (82%) received rate-limiting or anti-arrhythmic monotherapy, while 1 patient received a combination of amiodarone and digoxin.

Reference

Sammut MA, Condliffe R, Elliot C, et al. Atrial flutter and fibrillation in patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension in the ASPIRE registry: comparison of rate versus rhythm control approaches. Int J Cardiol. Published online September 13, 2022. doi:10.1016/j.ijcard.2022.09.031