Factores de riesgo para la presentación de arritmias supraventriculares en pacientes residentes en gran altitud

José Beraún-Barrantes; Anibal Diaz-Lazo; Raúl Montalvo

doi:10.47487/apcyccv.v7i1.584

Authors

José Beraún-Barrantes Escuela de Posgrado Universidad de Huánuco, Huánuco, Perú. https://orcid.org/0000-0001-8979-2734
Anibal Diaz-Lazo Escuela de Posgrado Universidad de Huánuco, Huánuco, Perú; Hospital Regional Clínico Quirúrgico «Daniel Alcides Carrión», Huancayo, Perú. https://orcid.org/0000-0002-9282-9435
Raúl Montalvo Hospital Regional Clínico Quirúrgico «Daniel Alcides Carrión», Huancayo, Perú. https://orcid.org/0000-0003-0227-8850

DOI:

https://doi.org/10.47487/apcyccv.v7i1.584

Keywords:

Arrhythmia, Blood Pressure, Hypertension, Altitude

Abstract

Objective. To determine the risk factors associated with the occurrence of supraventricular arrhythmias (SVA) among residents at high altitude. Material and methods. We conducted an analytical observational casecontrol study, including 24-hour electrocardiographic monitoring and transthoracic echocardiography in 192 individuals. Logistic regression analysis was used for statistical evaluation. Results. The study included 96 cases and 96 controls. Mean age was higher among cases than controls (65.9 ± 13.6 vs. 47.5 ± 19.5 years; p<0.001). Progressive increases in age, systolic blood pressure, and pulse pressure were significantly associated with a higher incidence of SVA. In multivariable analysis, hypertension (Odds Ratio [OR] = 3.43, 95% confidence interval [CI]: 1.64-7.16; p<0.001) and pulse pressure greater than 50 mmHg (OR = 3.27, 95% CI: 1.61-6.65; p=0.001) were independently associated with the presence of SVA. Hypertensive patients had more than a threefold increased likelihood of developing SVA compared with normotensive individuals. Episodes of supraventricular tachycardia were significantly more frequent among hypertensive participants than among non-hypertensive participants (60.6% vs. 39.4%; p<0.001). Conclusion: Hypertension and elevated pulse pressure are significant risk factors for the development of SVA among residents at high altitude. Further studies are warranted to clarify the clinical implications for prevention and management of SVA in hypertensive patients.

Downloads

Download data is not yet available.

References

Ray L, Geier C, DeWitt KM. Pathophysiology and treatment of adults with arrhythmias in the emergency department, part 1: Atrial arrhythmias. Am J Health Syst Pharm. 2023;80(16):1039- 1055. doi: 10.1093/ajhp/zxad108.

Sanchez-Borque P, Bravo Calero L, Miracle Blanco A, Garcia Talavera C, Porta Sanchez A, Cabrera Rodriguez JA, et al. Supraventricular Tachycardias. Medicine. 2021; 13(45): 2632-2640 https://doi.org/10.1016/j.med.2021.11.003

Applegate TE. Atrial arrhythmias. Prim Care. 2000;27(3):677- 708;vi. doi: 10.1016/s0095-4543(05)70169-x.

Brugada J, Katritsis DG, Arbelo E, Arribas F, Bax JJ, BlomströmLundqvist C, et al. 2019 ESC Guidelines for the management of patients with supraventricular tachycardiaThe Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology (ESC). Eur Heart J. 2020;41(5):655- 720. doi: 10.1093/eurheartj/ehz467.

Liu CM, Chang SL, Yeh YH, Chung FP, Hu YF, Chou CC, et al. Enhanced detection of cardiac arrhythmias utilizing 14-day continuous ECG patch monitoring. Int J Cardiol. 2021;332:78-84. doi: 10.1016/j.ijcard.2021.03.015.

Aidietis A, Laucevicius A, Marinskis G. Hypertension and cardiac arrhythmias. Curr Pharm Des. 2007;13(25):2545-55. doi: 10.2174/138161207781663037.

Afzal MR, Savona S, Mohamed O, Mohamed-Osman A, Kalbfleisch SJ. Hypertension and Arrhythmias. Heart Fail Clin. 2019;15(4):543- 550. doi: 10.1016/j.hfc.2019.06.011.

Naser N, Pepic E, Avdic S. The Diagnostic Value of Combined 24-h BP and ECG Holter Monitoring in Detection of Cardiac Arrhythmias in Patients with Arterial Hypertension. Acta Inform Med. 2022;30(1):69-75. doi: 10.5455/aim.2022.30.69-75.

Lip GYH, Coca A, Kahan T, Boriani G, Manolis AS, Olsen MH, et al. Hypertension and cardiac arrhythmias: a consensus document from the European Heart Rhythm Association (EHRA) and ESC Council on Hypertension, endorsed by the Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS) and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE). Europace. 2017;19(6):891-911. doi: 10.1093/ europace/eux091.

Yiu KH, Tse HF. Hypertension and cardiac arrhythmias: a review of the epidemiology, pathophysiology and clinical implications. J Hum Hypertens. 2008;22(6):380-8. doi: 10.1038/jhh.2008.10.

Woods DR, Boos C, Roberts PR. Cardiac arrhythmias ath high altitude. J R Army Med Corps. 2011;157(1): 59-62 doi: 10.1136/ jramc-157-01-10.

Boos CJ, Holdsworth DA, Woods DR, O'Hara J, Brooks N, Macconnachie L, et al. Assessment of Cardiac Arrhythmias at Extreme High Altitude Using an Implantable Cardiac Monitor: REVEAL HA Study (REVEAL High Altitude). Circulation. 2017;135(8):812-814. doi: 10.1161/CIRCULATIONAHA.116.026584.

Berthelsen LF, van Diepen S, Steele AR, Vanden Berg ER, Bird J, Thrall S, et al. Duration at high altitude influences the onset of arrhythmogenesis during apnea. Eur J Appl Physiol. 2022;122(2):475-487. doi: 10.1007/s00421-021-04842-x.

Sherpa K, Sherpa PP, Sherpa T, Rothenbuhler M, Ryffel C, Sherpa D, et al. Risk of Cardiac Arrhytmias Among Climbers on Mount Everest. JAMA Cardiol. 2024; 9(5): 480-485 doi: 10.1001/ jamacardio.20240364

Kujanik S, Snicak M, Vokal J, Podracky J, Koyal J. Periodicity of arrhythmias in healthy elderly men at the moderate altitude. Physiol Res. 2000; 49(2): 285-7.

Tinoco-Solorzano A, Nieto-Estrada VH, Velez-Paez DM, MolanoFranco D, Viruez-Soto A, Villacorta-Cordova F et al. Medicina Intensiva en la altitud. Revision de alcance. Rev Med Inten Cuidados Críticos. 2020;13(4):218-225 doi: htpps://10.37463/ intens-samay/0024

Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015;28(1):1-39. e14. doi: 10.1016/j.echo.2014.10.003.

Zhao X, Feng Q, Wahid A, Wang X, Wen J, Jiang W, et al. Sex differences in the association between blood pressure and atrial fibrillation: A case -control study. Front Cardiovascular Med. 2022;9:1061240. doi: 10.3389/fcvm.2022.1061240.

McEvoy JW, McCarthy CP, Bruno RM, Brouwers S, Canavan MD, Ceconi C, et al. 2024 ESC Guidelines for the management of elevated blood pressure and hypertension. Eur Heart J. 2024;45(38):3912-4018. doi: 10.1093/eurheartj/ehae178.

Diaz A. factores de reisgo cardiovascular y disfunción endotelial en adultos que viven a gran altura. Act Med Peru. 2016;23(4): 289-295 .

Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39(33):3021-3104. doi: 10.1093/ eurheartj/ehy339.

Van Gelder IC, Rienstra M, Bunting KV, Casado-Arroyo R, Caso V, Crijns HJGM, et al. ESC Scientific Document Group. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for CardioThoracic Surgery (EACTS). Eur Heart J. 2024;45(36):3314-3414. doi: 10.1093/eurheartj/ehae176.

Rojas EC, Mayaguari AE, Lopez JA, Roldan JV. Estudio transversal: Prevalencia de arritmias cardiacas supraventriculares y factores asociadas en pacientes adultos atendidos en consulta cardiológica. Hospital Jose Lanasco Arteaga. Cuenca 2018. Rev Med HJCA. 2021;13(2): 95-99.

Huang X, Hu L, Long Z, Wang X, Wu J, Cai J. Hypertensive Heart Disease: Mechanisms, Diagnosis and Treatment. Rev Cardiovasc Med. 2024;25(3):93. doi: 10.31083/j.rcm2503093.

Baguet JP, Erdine S, Mallion JM. European Society of Hypertension Scientific Newsletter: Update on Hypertension Management: Hypertension and dysrhythmias. J Hypertens. 2006;24(2):409-11. doi: 10.1097/01.hjh.0000199806.03058.a3.

Cai P, Zhong W, Wang Y, Wang X. Effects of white-coat, masked and sustained hypertension on coronary artery stenosis and cardiac arrhythmia. Hypertens Res. 2020;43(2):121-131. doi: 10.1038/s41440-019-0342-3.

Tanasă IA, Alexandrescu DM, Costache II. The incidence of supraventricular arrhythmias in patients with essential arterial hypertension--clinical and evolutive correlations. Rev Med Chir Soc Med Nat Iasi. 2014;118(2):364-7.

Varvarousis D, Kallistratos M, Poulimenos L, Triantafyllis A, Tsinivizov P, Giannakopoulos A, et al. Cardiac arrhythmias in arterial hypertension. J Clin Hypertens (Greenwich). 2020;22(8):1371-1378. doi: 10.1111/jch.13989.

Robinson S, Ring L, Oxborough D, Harkness A, Bennett S, Rana B, et al. The assessment of left ventricular diastolic function: guidance and recommendations from the British Society of Echocardiography. Echo Res Pract. 2024;11(1):16. doi: 10.1186/ s44156-024-00051-2.

Marazzato J, Blasi F, Golino M, Verdecchia P, Angeli F, De Ponti R. Hypertension and arryhthmias: A clinical overview of the Pathophysiology-Driven Management of Cardiac Arryhthmias in Hypertensive Patients. J Cardiovasc Dev Dis. 2022;9(4):110. doi: 10.3390/jcdd9040110.

Gasser S, Gaugl K, Kraigher-Krainer E, Zunik S, Gasser R. Nevibolol reduces symptoms of cardiac arrhythmias in patients with arterial hypertension: An observational pilot study. J Clinic Basic Cardiol. 2006;9(1-4):27-30.