ArticleFrontiers in cardiovascular medicine2026
Risk factors for different types of arrhythmias and their prognostic impact in patients with heart failure and concomitant pulmonary hypertension (PH-LHF): a large-scale retrospective cohort study.
Article in Frontiers in cardiovascular medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Pulmonary hypertension with left heart failure (PH-LHF) is a prevalent phenotype with distinct hemodynamics. The arrhythmic landscape-encompassing atrial tachyarrhythmias (AT), ventricular tachyarrhythmias (VT), and bradyarrhythmias (BA)-remains poorly characterized. We aimed to identify phenotype-specific risk factors and prognostic impacts of these arrhythmias in PH-LHF. Methods: This retrospective cohort study included 1,530 PH-LHF patients. Patients were stratified into four mutually exclusive groups based on hierarchical rhythm documentation: No Arrhythmia (NA), AT, VT, and BA. Multivariate Logistic regression and Cox proportional hazards models (adjusting for NT-proBNP, ischemic etiology, and treating device therapy as time-dependent covariates) were utilized to determine independent predictors of each arrhythmia type and to assess their impact on all-cause mortality and heart failure rehospitalization over a median follow-up of 38 months. Results: The overall prevalence of clinically significant arrhythmias was 68.9%, comprising AT (42.2%), VT (18.0%), and BA (8.7%). Left atrial volume index (LAVI) >40 ml/m² (OR 2.41, 95% CI 1.85-3.15) was the strongest predictor of AT. Conversely, a marker of right ventricular dysfunction (TAPSE <16 mm) was a potent independent predictor of VT (OR 3.25, 95% CI 2.38-4.45), largely independent of LVEF. Prognostically, VT was associated with the highest risk of all-cause mortality (HR 2.56, 95% CI 1.95-3.36), whereas AT was the primary driver of rehospitalization (HR 1.92, 95% CI 1.62-2.28). The prevalence of VT increased disproportionately with PH severity. Overlap analysis revealed that 15% of patients in the VT group also had documented AT, and secondary time-dependent analyses confirmed the independent prognostic weight of VT. Conclusion: Arrhythmia burden in PH-LHF is substantial and biologically distinct. The "right heart phenotype" drives malignant ventricular arrhythmias and mortality, while the "left atrial phenotype" drives atrial arrhythmias and morbidity. These findings advocate for a precision medicine approach, suggesting that RV monitoring could serve as a valuable tool for risk enrichment in SCD risk stratification in this vulnerable population, pending prospective validation.
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