Atrial arrhythmia (AA) are common in patients with pulmonary hypertension (PH) and contribute to morbidity and mortality. Given the growing PH population, understanding the pathophysiology, clinical impact, and management of AA in PH is important. AA occurs in PH with a 5-year incidence of 10% to 25%. AA confers a higher morbidity and mortality, and restoration of normal sinus rhythm improves survival and functionality. AA is thought to develop because of structural alterations of the right atrium caused by changes to the right ventricle (RV) due to elevated pulmonary artery pressures. AA can subsequently worsen RV function. Current guidelines do not provide comprehensive recommendations for the management of AA in PH. Robust evidence to favor a specific treatment approach is lacking. Although the role of medical rate or rhythm control, and the use of cardioversion and ablation, can be inferred from other populations, evidence is lacking in the PH population. Much remains to be determined regarding the optimal management strategy. We present here our institutional approach and discuss areas for future research. This review highlights the epidemiology and pathophysiology of AA in patients with PH, describes the relationship between AA and RV dysfunction, and discusses current management practices. We outline our institutional approach and offer directions for future investigation.

中文翻译：

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肺动脉高压患者的房性心律失常

房性心律失常（AA）在肺动脉高压（PH）患者中很常见，并导致发病率和死亡率。鉴于 PH 人群不断增长，了解 AA 在 PH 中的病理生理学、临床影响和治疗非常重要。 AA 发生在 PH 中，5 年发病率为 10% 至 25%。 AA 导致较高的发病率和死亡率，恢复正常窦性心律可提高生存率和功能。人们认为 AA 的形成是由于肺动脉压力升高导致右心室 (RV) 变化导致右心房结构改变所致。 AA 随后会使 RV 功能恶化。目前的指南没有为 PH 中的 AA 管理提供全面的建议。缺乏支持特定治疗方法的有力证据。尽管可以从其他人群中推断出医疗频率或节律控制以及心脏复律和消融的使用的作用，但在 PH 人群中缺乏证据。关于最佳管理策略还有很多事情有待确定。我们在这里介绍我们的机构方法并讨论未来研究的领域。本综述重点介绍了 PH 患者中 AA 的流行病学和病理生理学，描述了 AA 与 RV 功能障碍之间的关系，并讨论了当前的管理实践。我们概述了我们的机构方法并为未来的调查提供了方向。