Predictors and prognostic significance of tachycardiomyopathy: insights from a cohort of 1269 patients undergoing atrial flutter ablation

Abstract

BackgroundAtrial flutter-related tachycardiomyopathy (AFL-TCM) is a rare and treatable cause of heart failure. Little is known about its epidemiology and long-term prognosis. Our aims are to determine the prevalence, predictors and outcomes of AFL-TCM. Methods and resultsA total of 1269 patients were referred for radiofrequency ablation of AFL between January 1996 and September 2014; 184 had reduced left ventricular ejection fraction (LVEF <40%). At 6 months after AFL ablation, 103 patients (8.1% of the population, 56% of patients with baseline LVEF <40%) had marked LVEF improvement: these were considered to have AFL-TCM. Patients with persisting reduced LVEF were considered to have systolic dysfunction unrelated to AFL. Patients were followed for a median (percentile 25-75 ) of 1.15 (0.4-2.8) years. Patients with AFL-TCM were younger, had lower prevalence of ischaemic cardiomyopathy and used less antiarrhythmic drugs than patients with systolic dysfunction unrelated to AFL. In multivariable analysis, ischemic cardiomyopathy [odds ratio (OR) = 0.32, 95% confidence interval (CI) 0.15-0.68) P = 0.003] and prescription of antiarrhythmic drug before ablation [OR = 0.41, 95% CI 0.20-0.84, P = 0.02] were significantly associated with a lower probability of LVEF improvement during follow-up. Patients with AFL-TCM had similar survival to patients without systolic dysfunction at baseline [hazard ratio (HR) = 0.96 95% CI 0.34-2.65, P = 0.929], whereas patients with systolic dysfunction unrelated to AFL had higher mortality rates compared with patients without systolic dysfunction at baseline [HR = 2.88, 95% CI 1.45-5.72, P = 0.002].

April 2016 at a glance. Focus on cardiac remodeling, biomarkers and treatment

“…An ischemic etiology and prescription of antiarrhythmic drugs were associated with a lower likelihood of LVEF improvement. Patients who improved their LVEF had similar outcomes as those with a normal LVEF at baseline whereas those with a persistent low LVEF post‐ablation had an almost 3‐fold higher mortality rate …”

Unresolved Issues and Future Perspectives

“…It has already been shown that post-myocarditis DCM could have a better prognosis compared to the idiopathic form [2]. Moreover, it is well known that secondary forms show reversibility after removing the trigger factors [3][4][5]. More undefined is the prognostic relevance of certain gene mutations in the setting of genetically determined DCM.…”

Predictors of the occurrence of cardiovascular events in patients with atrial flutter during long-term follow-up

“…Це більше, ніж в інших дослідженнях, де ФП реєструється упродовж 5 років у 30 % пацієнтів з ізольованим ТП І типу [8]. Відомо, що поєднання ТП з ФП асоціюється з погіршанням клінічного перебігу [17], збільшенням ризику рецидиву аритмії після катетерних втручань [3], але не має значущого незалежного впливу на прогноз [4,7,16]. Останнім часом з'явилися дані про суттєві відмінності прогнозу пацієнтів з ізольованими формами ФП та ТП.…”

“…Епідеміологія та прогноз тахізалежної кардіоміопатії при ТП залишаються недостатньо вивченими; втім, за даними когортного дослідження 1269 хворих після абляції ТП, у 56 % пацієнтів з фракцією викиду ЛШ менше 40 % через 6 місяців вдалося поліпшити показник систолічної функції міокарда [3], що є достатньо вагомим аргументом на користь відновлення синусового ритму в пацієнтів з ТП.…”