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Expert opinion suggests that management of atrial arrhythmias in patients with pulmonary hypertension should aim to restore sinus rhythm. This is clinically challenging in pulmonary hypertension patients with coexisting chronic lung disease, as there is controversy on the use of rhythm control agents; generally, in regard to either their pulmonary toxicity profile or the lack of evidence supporting their use. Rate control methods are largely focused on the use of beta blockers and calcium channel blockers. Concerns regarding their use involve their negative inotropic properties in cor pulmonale, the risk of bronchospasm associated with beta blockers, and the potential for ventilation\/perfusion mismatching associated with calcium channel blockers. While digoxin has been associated with promising outcomes during acute right ventricular failure, there is limited evidence to suggest its routine use. Electrical cardioversion is associated with a high failure rate and it frequently requires multiple attempts. Radiofrequency catheter ablation is a more definitive approach, but concerns surrounding mechanical ventilation and sedation limit its applicability in decompensated pulmonary hypertension. Individual approaches are needed to address atrial arrhythmia management during acute episodes of respiratory failure.<\/jats:p>","DOI":"10.1177\/2045894020910685","type":"journal-article","created":{"date-parts":[[2020,2,19]],"date-time":"2020-02-19T15:24:24Z","timestamp":1582125864000},"page":"1-13","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":20,"title":["Atrial arrhythmias in chronic lung disease\u2010associated pulmonary hypertension"],"prefix":"10.1002","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8917-2807","authenticated-orcid":false,"given":"Cyrus A.","family":"Vahdatpour","sequence":"first","affiliation":[{"name":"Department of Medicine Pennsylvania Hospital University of Pennsylvania Health System Philadelphia PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey J.","family":"Luebbert","sequence":"additional","affiliation":[{"name":"Department of Cardiology Pennsylvania Hospital University of Pennsylvania Health System Philadelphia PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harold I.","family":"Palevsky","sequence":"additional","affiliation":[{"name":"Pulmonary, Allergy, and Critical Care Division Department of Medicine Penn Presbyterian Medical Center Philadelphia PA USA"},{"name":"Perelman School of Medicine, University of Pennsylvania Philadelphia PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,3]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.110.960435"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehv317"},{"key":"e_1_2_9_4_1","first-page":"1801914","article-title":"Pulmonary hypertension in chronic lung disease and hypoxia","author":"Nathan SD","year":"2018","journal-title":"Eur Respir J"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jjcc.2016.12.013"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2014.07.079"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2015.09.039"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2006.09.008"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.15420\/aer.2018.3.2"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1177\/1074248418757010"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euq326"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1042\/CS20110178"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1177\/2045894019834890"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.107.754564"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2012.06.024"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8167.2011.02255.x"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.164.4.2007085"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200912-1856OC"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12890-019-0848-0"},{"key":"e_1_2_9_20_1","first-page":"215","article-title":"Autonomic dysfunction in patients with chronic obstructive pulmonary disease (COPD)","volume":"2","author":"Gestel AJR","year":"2010","journal-title":"J Thorac Dis"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.84.3.1024"},{"key":"e_1_2_9_22_1","first-page":"IV9096","article-title":"Neurohumoral activation in preclinical heart failure. 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