Recovery of systolic and diastolic function after ablation of incessant supraventricular tachycardia

Abstract

We report a case of a 26-year-old woman who presented to our hospital with arrhythmia and heart failure. She had an incessant supraventricular tachycardia, which was not reversible with electrical cardioversion. Echocardiogram showed a severe LV systolic and diastolic dysfunction. After radiofrequency catheter ablation, LV function returned to normal. This article is intended to show a case with tachycardiomyopathy, which is considered the most frequently unrecognized curable cause of heart failure, and to demonstrate that early treatment allows the recovery to a normal LV systolic and diastolic function, preventing irreversible structural cardiac damage. It is very likely that some patients with idiopathic dilated cardiomyopathy and chronic atrial fibrillation or other chronic arrhythmia actually have a curable tachycardiomyopathy. Case ReportA 26-year-old mulatto female patient was admitted to the Heart Institute (InCor) with dilated cardiomyopathy, which had been diagnosed 14 months before admission. During that period, she was receiving lisinopril 10 mg/day and digoxin 0.25 mg/day. Two weeks prior to admission, her condition had become worse. At admission, she was in New York Heart Association functional class II with atypical chest pain, palpitations and dyspnoea of effort.On examination she presented good general condition, blood pressure 100Â60 mmHg and heart rate 126 bpm. The cardiac impulse was diffuse and displaced inferior and laterally. The cardiac rhythm was regular, with S 3 gallop, increased P 2 and mild holosystolic murmur in the mitral and tricuspid area. The rest of her physical exam was normal. Her thyroid hormones and ferritin were within the normal range, and Chagas' disease serology was negative. The electrocardiographic (ECG) characteristics of the tachycardia did not allow differentiation between atrial, sinoatrial or AV type Coumel (Fig. 1). A 24-h Holter monitoring showed sinus rhythm alternated with incessant supraventricular tachycardia. The mean heart rate was 119 bpm (44-166 bpm), and the incessant supraventricular tachycardia was present for more than two thirds of the 24-h period.Standard transthoracic echocardiogram showed a dilated and severe globally hypokinetic left ventricle (LV, Fig. 2), left atrium of 47 mm, mild mitral and tricuspid regurgitations, and a restrictive left ventricular filling pattern. Electrical cardioversion was performed without success. The patient underwent electrophysiological testing, and was submitted to successful transcatheter radiofrequency ablation of accessory pathway located in the right posterio-septal zone. The patient has remained well and in sinus rhythm for the last 88 months following resolution of the tachycardia. The echocardiogram performed 6 months after the procedure showed an improvement in LV ejection fraction (Fig. 2) and, when repeated 88 months later, showed a totally normal systolic and diastolic function. Normal diastolic function was confirmed by pulsed-wave tissue Doppler 1388-9842/$ -see front matter D

Taquicardiomiopatía, causa reversible de insuficiencia cardiaca: caso clínico

“…La taquicardiomiopatía puede ser inducida por arritmias supraventriculares y ventriculares. Puede ser difícil defi nir la relación causa efecto cuando la miocardiopatía y la taquicardia son encontradas simultáneamente [1][2][3][4][5][6][7] . La taquicardiomiopatía se puede clasifi car en dos categorías: "puras" cuando la taquicardia crónica se instala en un corazón normal y es el único agente responsable de la disfunción del VI.…”

Supraventricular Tachyarrhythmias

“…1 The most clinically useful classification system broadly groups SVTs into atrial tachyarrhythmias or AV node-dependent tachyarrhythmias. [3][4][5][6][7][8] This is known as tachycardiomyopathy or tachycardia-induced cardiomyopathy and cannot be distinguished initially from idiopathic dilated cardiomyopathy (DCM). The importance of managing SVTs has become clearer in recent years.…”

“…2 Such classification helps us to guide therapy of these abnormal heart rhythms and is discussed in detail later in this chapter. 4 SVTs can also result in sudden death, although less often than does sustained ventricular tachycardia. Not only can these abnormal rhythms result from structural heart disease, but they can be the cause of structural heart disease as well.…”

Tachycardia-Induced Cardiomyopathy (Tachycardiomyopathy)

“…Tachycardia-induced cardio-myopathy can occur at any age. It has been reported in infants, children [12], adolescents [13], and adults [14, 15]. …”