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Arrhythmic substrates include electrical remodeling (ion channel imbalance, gap junction protein connexin 43 (Cx43) dysfunction, and autonomic neuropathy), structural remodeling (right ventricular hypertrophy\/fibrosis), metabolic disorders (mitochondrial dysfunction and the Warburg effect), and chronic inflammation. Clinically, PH-related atrial arrhythmias, particularly atrial fibrillation (AF)\/flutter (AFL), are the most common. Diagnosis often requires combining ambulatory electrocardiography and implantable cardiac monitoring to detect subclinical events. Current treatment methods include optimizing PH-targeted therapy (e.g., dual- or triple-targeted drug therapy, soluble guanylate cyclase (sGC) stimulators), antiarrhythmic drugs, and catheter ablation, as well as emerging therapies such as Cx43 modulators, gene therapy (targeting bone morphogenetic protein receptor type 2 (BMPR2)\/switch-independent 3A (SIN3A)), and microRNA (miRNA)-based regulation. Future work should focus on elucidating underlying mechanisms, developing precise risk stratification models, and formulating targeted individualized intervention strategies.<\/jats:p>","DOI":"10.31083\/rcm52744","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T14:57:11Z","timestamp":1790693831000},"source":"Crossref","is-referenced-by-count":0,"title":["Mechanisms and Advances in the Treatment of Arrhythmias Associated With Pulmonary Hypertension"],"prefix":"10.31083","volume":"27","author":[{"given":"Caijuan","family":"Huan","sequence":"first","affiliation":[{"name":"Department of Respiratory Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, 310003 Hangzhou, Zhejiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhaoming","family":"Fu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, 310003 Hangzhou, Zhejiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rong","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, 310003 Hangzhou, Zhejiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuo","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, 310003 Hangzhou, Zhejiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, 310003 Hangzhou, Zhejiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, 310003 Hangzhou, Zhejiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"16242","published-online":{"date-parts":[[2026,9,4]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","unstructured":"Reddy SA, Nethercott SL, Khialani BV, Grace AA, Martin CA. 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