Arrhythmias in right heart disease

Abstract

Right heart disease can be associated with increased risk for arrhythmias, both ventricular and supraventricular. Right sided arrhythmias may occur in the setting of structural disease predominantly affecting the right heart-such as cardiomyopathies (arrhythmogenic right ventricular dysplasia, cardiac sarcoidosis) and congenital heart disease (corrected tetralogy of Fallot, Ebstein's anomaly, atrial septal defect), as well as in the absence of structural heart disease, with substrate (Mahaim fibers, Coumel type tachycardia) or without substrate (idiopathic right ventricular outflow tract ventricular tachycardia). The most common cause for right heart failure is secondary pulmonary hypertension due to left heart diseases, a setting in which the underlying left heart condition will be the main determiner for prognosis and risk of arrhythmia. Still, right heart failure secondary to pulmonary arterial hypertension is also associated with increased risk for arrhythmic events. Advanced cardiac imaging, especially cardiac MRI, as well as invasive procedures (right/left heart catherization; electrophysiological study; endomyocardial biopsy) play an important role in the differential diagnosis. Modern treatment relies on interventional techniques (implantable cardioverter defibrillator; radiofrequency ablation).