Right atrial flutter isthmus ablation is feasible and results in acute clinical improvement in patients with persistent atrial flutter and severe pulmonary arterial hypertension

<p>Pulmonary arterial hypertension (PAH) is a rare condition characterized by an increase in pulmonary arterial resistance leading to right heart failure and death. Arrhythmias are a growing problem in PAH; therefore, maintenance of sinus rhythm is considered to be an important treatment aim in these patients. We described the case of a 46-year-old woman with HIV-associated pulmonary arterial hypertension who developed atrial flutter. After treatment with bosentan, it was observed a significant improvement in clinical and haemodynamic parameters. In addition, the AFL, which had previously persisted to both antiarrhythmic drug therapy and electrical stimulation, and had recurred after transthoracic electrical cardioversion, disappeared in absence of any antiarrhythmic drug. Though the precise factors responsible for supraventricular arrhythmogenesis are still largely obscure, it is likely that initiation and maintenance of AFL may depend on all the conditions that can lead to increase in right atrial pressure, size, and wall stress, such as PAH. In our case, bosentan reduced both mean pulmonary artery pressure (mPAP) value and right heart chambers pressures. Therefore, it is conceivable that with the anatomical substrate needed for the maintenance of AFL being disappeared, sinus rhythm was restored.</p>

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Faculty Opinions recommendation of Transcatheter Potts shunt creation in patients with severe pulmonary arterial hypertension: initial clinical experience.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717981968.793474162 ◽

2013 ◽

Author(s):

Vinicio de Jesus Perez

Keyword(s):

Pulmonary Arterial Hypertension ◽

Arterial Hypertension ◽

Clinical Experience ◽

Pulmonary Arterial ◽

Severe Pulmonary Arterial Hypertension ◽

Initial Clinical Experience

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Faculty Opinions recommendation of Formation of plexiform lesions in experimental severe pulmonary arterial hypertension.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718018224.793478126 ◽

2013 ◽

Author(s):

Vinicio de Jesus Perez

Keyword(s):

Pulmonary Arterial Hypertension ◽

Arterial Hypertension ◽

Plexiform Lesions ◽

Pulmonary Arterial ◽

Severe Pulmonary Arterial Hypertension

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Study of the effect of Occlutech Atrial Flow Regulator on symptoms, hemodynamics, and echocardiographic parameters in advanced pulmonary arterial hypertension

Pulmonary Circulation ◽

10.1177/2045894021989966 ◽

2021 ◽

Vol 11 (1) ◽

pp. 204589402198996

Author(s):

Kothandam Sivakumar ◽

Gopalavilasam R. Rohitraj ◽

Monica Rajendran ◽

Nithya Thivianathan

Keyword(s):

Pulmonary Arterial Hypertension ◽

High Risk ◽

Arterial Hypertension ◽

Right Heart Failure ◽

Right Atrial ◽

Echocardiographic Parameters ◽

Procedural Complications ◽

Pulmonary Arterial ◽

Flow Regulator ◽

Risk Predictors

Optimal sized balloon atrial septostomy improves hemodynamics in advanced pulmonary arterial hypertension. Occlutech Atrial Flow Regulator is designed to provide an atrial septal fenestration diameter titrated according to the age and right atrial pressures. This observational study analyzed symptoms, exercise distance, oxygen saturations, hemodynamics and echocardiographic parameters after Atrial Flow Regulator implantation in patients with syncope or right-heart failure. Patients with high-risk predictors of mortality during septostomy were scrutinized. Thirty-nine patients (9 children) with syncope (34/39) or right-heart failure (27/39) underwent Atrial Flow Regulator implantation without procedural complications. Six-minute walk distance increased from 310 ± 158.2 to 376.4 ± 182.6 m, none developed syncope. Oxygen saturations reduced from 96.4 ± 6.4% to 92 ± 4.9% at rest and further to 80.3 ± 5.9% on exercise. Right atrial pressures reduced from 9.4 ± 5 (2–27) mmHg to 6.9 ± 2.6 (1–12) mmHg, while cardiac index increased from 2.4 ± 0.8 (0.98–4.3) to 3 ± 1 (1.1–5.3) L/min/m2 and systemic oxygen transport increased from 546.1 ± 157.9 (256.2–910.5) to 637.2 ± 191.1 (301.3–1020.2) ml/min. Echocardiographic improvement included significant reduction of pericardial effusion and inferior caval congestion at a median follow-up of 37 months. Overall survival improved except two early and one late deaths in high-risk patients. Five of seven patients with advanced disease and key hemodynamic predictors of mortality survived. Acute hemodynamic benefits in pulmonary arterial hypertension after Atrial Flow Regulator were improved cardiac output, systemic oxygen transport, and reduced right atrial pressures. Improvement of symptoms especially syncope, exercise duration, and right ventricular systolic function as well as device patency were sustained on mid-term follow-up. Implantation was safe in all including young children without procedural complications. Mortality was noted only in patients who had high-risk predictors and patients at advanced stage of the disease.

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