Diagnostic Approach and Treatment Strategy in Tachycardia‐induced Cardiomyopathy

Abstract

Background: Due to the absence of differential guidelines for heart failure with tachyarrhythmia, it is difficult to diagnose tachycardia-induced cardiomyopathy (TIC) at the initial visit. Furthermore, clinical outcomes of rate versus rhythm control in TIC are unclear. Hypothesis: Because the etiology of TIC is different from dynamic cardiomyoplasty (DCMP), differential parameters may be present. Methods: We assessed 21 patients with TIC (15 men; mean age, 50 ± 14 years) and 21 control patients with idiopathic DCMP. We assessed clinical courses, echocardiographic parameters, as well as outcomes by treatment.Results: In the TIC group, the related tachyarrhythmias were atrial fibrillation (n = 12), atrial flutter (n = 5), atrial tachycardia (n = 3) and paroxysmal supraventricular tachycardia (n = 1). After treatment, all patients became asymptomatic and the ejection fraction (EF) improvement ( EF 15%) was observed in all patients (left ventricular ejection fraction [LVEF], 30 ± 11% initial versus 58 ± 6% last ). In the idiopathic DCMP group, no patient showed EF improvement (EF increase 5%), and 4 patients (19%) underwent heart transplantation. Left ventricle (LV) mass indices, volumes adjusted by BSA, and dimensions were smaller in the TIC group than in the idiopathic DCMP group. Of those, LV end-diastolic dimension was the only independent predictor of TIC in multiple regression analysis (odds ratio [OR] 0.742 per 1 mm, 95% confidence ratio [CI] 0.618 to 0.891, p = 0.001). The Association of University Cardiologists (AUC) was 0.908 on receiver-operating characteristic (ROC) curve analysis and LV end-diastolic dimension 61 mm could predict TIC with a sensitivity of 100% and a specificity of 71.4%. After restoration of sinus rhythm (n = 8), one experienced recurrent TIC after discontinuation of amiodarone. After control of heart rate (n = 13), one experienced recurrent TIC due to poor control of heart rate (log-rank test, p = 0.808). There were no differences in the echocardiographic parameters between the 2 groups before and after treatment except for the larger initial LV volumes in the rhythm control. Conclusions: In patients presented as heart failure with tachyarrhythmia, initial echocardiographic parameters, especially LV end-diastolic dimension, help to differentiate TIC from idiopathic DCMP. Rate control was as effective as rhythm control for EF improvement and prognosis.

The effect of radiofrequency catheter ablation of frequent premature ventricular complexes and arrhythmia burden on left ventricular function

“…They also defined the additional group of "mixed" TIC, who experience improvement of LV function after successful restoration of normal cardiac rhythm despite the presence of concomitant SHD [12]. However, the median LVEF improvement was more prominent in patients with pure TIC (DLVEF > 15%) compared to those with mixed TIC (DLVEF > 5%) [13]. The mean improvement of LV function in our patients was 8.3% ± 1.8%.…”

Newly developed atrial fibrillation progresses to a more severe INTERMACS score in a patient with advanced heart failure due to dilated cardiomyopathy

“…In contrast, a newly developed AF, as presented in the current case, more significantly impacts the course of HF than an existing AF 8, 9, 10. According to the mechanism of it, the onset of AF certainly has a negative impact on heart function because of an increased mitral and tricuspid regurgitation and the negative impact on LV function 11, 12, 13, 14, 15, 16.…”

Results of radiofrequency ablation in children with tachycardia-induced cardiomyopathy

“…As in some cases in our study, some patients with TIC may receive treatment for misdiagnoses of myocarditis or dilated cardiomyopathy related to other causes. In two small studies, it was postulated that the only distinctive factor between TIC and dilated cardiomyopathy is that TIC patients tend to have lower LVEDD (13,14). However, the most striking difference between two conditions is the recovery of left ventricular function following eradication of the tachyarrhythmia in TIC patients, which highlights the importance of pursuing an aggressive strategy to keep the arrhythmia under control.…”