This review establishes a possible link between atrial fibrillation and pulmonary hypertensionPulmonary Hypertension (PH) High pressure in the blood vessels leading from the heart to the lungs is called pulmonary hypertension. The arteries in the lungs and the right side of the heart are affected by pulmonary hypertension. If untreated, the right side of the heart will weaken over time, eventually leading to heart failure and death. The WHO has defined five distinct groups of pulmonary hypertension, each with a different cause. CTEPH is a form of PH (WHO group 4). - References: mayoclinic.org and cdc.gov, including CTEPHChronic Thromboembolic Pulmonary Hypertension CTEPH is short for chronic thromboembolic pulmonary hypertension, a rare form of high blood pressure in the lungs caused by blood clots or narrowed blood vessels. High blood pressure in the lungs is often also called pulmonary hypertension.. The paper discusses potential causes and treatment options (reference at the bottom of the post).

I face an additional challenge: atrial fibrillation, commonly abbreviated as AF, AFib, or A-fib. In plain language, that’s an abnormal heartbeat, which I typically feel as a pounding sensation (palpitations) just above my abdomen. The arrhythmia originates in the upper chambers of the heart (atria). In my case, it’s almost certainly the right atrium.

It’s not good, and treatment is needed.

As is my habit, I try to learn as much as possible about these disorders. I used my favorite search engine and found a review paper by Wanamaker and colleagues.

Some points that I found relevant (from several papers):
If no source is mentioned, I am citing or paraphrasing Wanamaker et al., 2018. References are at the bottom of the post.

  • Olsson et al., 2018, followed 239 patients with idiopathic PAH (n=157) or CTEPH (n=82) and restricted their analysis to AF and atrial flutter.[9] This study found a cumulative atrial arrhythmia incidence of 25.1 % over 5 years of follow-up.
  • In their paper Olsson et al., 2018, conclude: A significant number of patients with PAH or inoperable CTEPH develop atrial flutter and fibrillation, frequently leading to clinical deterioration and right heart failure. Mortality is high when sinus rhythm cannot be restored.
  • Observational studies suggest that RA pressure and chamber size are important risk factors for atrial arrhythmia development.[9,10] Chronic RA pressure overload and stretching, along with chronic hypoxia, may alter the atrial substrate by promoting fibrosis and local tissue heterogeneities, predisposing to a risk for AF.
  • Patients with PAH have been shown to have increased sympathetic activity [25], and reduction of this sympathetic input may improve functional status.[26] The sympathetic autonomic system is recognized to play a significant role in initiating and perpetuating AF via enhanced automaticity, triggered activity, and an increase in delayed afterdepolarizations. It may even represent a therapeutic target for AF.
  • Rhythm control strategies have included pharmacological cardioversion with membrane-active antiarrhythmic drugs, electrical cardioversion, and catheter ablation. To date, all studies investigating rhythm control strategies have included small numbers of patients, and, in general, no standardized approach to rhythm control has been described.
  • Then follows a section on possible treatments and details of each of these methods.
  • European guidelines recommend that, where feasible, sinus rhythm control is the preferred first-line approach in managing atrial arrhythmias in PHPulmonary Hypertension (PH) High pressure in the blood vessels leading from the heart to the lungs is called pulmonary hypertension. The arteries in the lungs and the right side of the heart are affected by pulmonary hypertension. If untreated, the right side of the heart will weaken over time, eventually leading to heart failure and death. The WHO has defined five distinct groups of pulmonary hypertension, each with a different cause. CTEPH is a form of PH (WHO group 4). - References: mayoclinic.org and cdc.gov.

    Read the paper (reference below) to learn more about the probable link between atrial fibrillation and different types of pulmonary hypertension, along with potential treatment options. The Wanamaker paper is Open Access.

    References

    Wanamaker, B., Cascino, T., McLaughlin, V., Oral, H., Latchamsetty, R., & Siontis, K. C. (2018). Atrial Arrhythmias in Pulmonary Hypertension: Pathogenesis, Prognosis and Management. Arrhythmia & electrophysiology review, 7(1), 43–48. https://doi.org/10.15420/aer.2018.3.2 – I took the image at the top of this post from this reference.

    Olsson, K. M., Nickel, N. P., Tongers, J., & Hoeper, M. M. (2013). Atrial flutter and fibrillation in patients with pulmonary hypertension. International journal of cardiology, 167(5), 2300–2305. https://doi.org/10.1016/j.ijcard.2012.06.024