Pulmonary vascular disease & thromboembolism
Invasive and non-invasive mapping of the cardiac electromechanical substrate in pulmonary arterial hypertension
Authors' conclusion
RA dilatation in PAH and CTEPH is associated with slowed conduction, prolonged repolarization, and increased AV nodal refractoriness, providing a mechanistic substrate for atrial arrhythmias and conduction disease. These findings highlight structural-electrophysiological correlations that may guide arrhythmia risk assessment and targeted interventions in PH.
Study context
- Population
- Adult patients with pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension (PH) (chronic thromboembolic PH (CTEPH))non-invasive electrocardiographic imaging 30 · invasive right atrial (RA) electroanatomical mapping during ablation 10
- Exposure
- PAH patients versus matched controls; electrical parameters correlated with structural and functional measures
- Outcome
- Atrial activation time (non-invasive mapping)
Methodological detailsnon-invasive electrocardiographic imaging, invasive RA electroanatomical mapping during ablation, matched controls
- Non-invasive electrocardiographic imaging
- Invasive RA electroanatomical mapping during ablation
- Matched controls
Main finding
As reported in the abstract
PAH patients
72 ± 17
ms
Matched controls
46 ± 12
ms
P = 0.001
Observational data: associations, not effects.
Further findings
| Outcome | PAH patients | Matched controls | P value |
|---|---|---|---|
| Ventricular activation time (non-invasive mapping)Prolonged in PAH patients | 41 ± 13 ms | 31 ± 6 ms | P = 0.009 |
| Ventricular repolarization time (non-invasive mapping)Prolonged in PAH patients | 127 ± 51 ms | 87 ± 25 ms | P = 0.007 |
| Ventricular activation-recovery interval (non-invasive mapping)Prolonged in PAH patients | 292 ± 30 ms | 246 ± 25 ms | P = 0.001 |
RA dilatation vs atrial conduction and repolarization (non-invasive mapping)
- Slower atrial conduction R
- R = 0.51, P = .01
- Prolonged repolarization R
- R = 0.40, P = .02
RA volume vs atrial conduction velocity and atrioventricular (AV) nodal effective refractory period (invasive mapping)
- Atrial conduction velocity R
- R = −0.64, P = .05
- Atrioventricular (AV) nodal effective refractory period R
- R = 0.82, P = .03
Original publication
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