Tachycardia-mediated cardiomyopathy: Recognition and management

Abstract

Tachycardia-mediated cardiomyopathy is a cause of ventricular dysfunction due to, at least partially, persistent tachycardia leading to cellular and extracellular perturbations. Cardiomyopathy may take years to develop, but pharmacologic management to achieve rate control and reverse remodeling, as well as cardioversion or ablative strategies to stop the tachycardia, can result in rapid recovery from symptoms and gradual improvement in left ventricular ejection fraction. However, ultrastructural changes can remain and may lead to a rapid decline in ventricular function if tachycardia recurs. Ultrastructural changes may also explain a propensity toward sudden death even if the ejection fraction normalizes. Although the etiology, pathophysiology, and late clinical manifestations of tachycardia-mediated cardiomyopathy are beginning to be understood, investigation continues, focusing on prevention, early recognition, and acute and long-term management in an attempt to lessen heart failure and prevent risk of sudden death.

Reversible Dilated Cardiomyopathy: Into the Thaumaturgy of the Heart—Part 1

“…In addition, thyrotoxicosis can induce cardiomyopathy mediated by sustained tachycardia, but additional mechanisms are also involved. 39 TIC can also occur in patients with automatic atrial tachycardia atrioventricular nodal re-entry tachycardia, permanent reciprocating junctional tachycardia (PJRT), and accessory pathway tachycardia. TIC is classically defined as the reversible impairment of ventricular function induced by persistent arrhythmias.…”

“…During the early phase (3 to 7 days), LV dilation occurs and ejection fraction declines. 39 This early remodeling phase is adaptive and is not paralleled by reduction in cardiac output or systemic perfusion. By the second week, however, both an increase in central venous and pulmonary capillary wedge pressures and systemic vasoconstriction occur, 39 followed by symptoms of heart failure.…”

“…39 This early remodeling phase is adaptive and is not paralleled by reduction in cardiac output or systemic perfusion. By the second week, however, both an increase in central venous and pulmonary capillary wedge pressures and systemic vasoconstriction occur, 39 followed by symptoms of heart failure. A number of cellular and molecular events in response to the high ventricular rates occurs during a period of approximately 3 to 4 weeks and involve both extracellular matrix and myocyte remodeling.…”

Reversible Dilated Cardiomyopathy: Into the Thaumaturgy of the Heart - Part 2

“…For example, recognizing TIC is fundamental as LV dysfunction may be completely reversible once tachycardia has been controlled, even though it may have been so severe as to be considered for transplantation. 75 It is also important to note that a significant minority of cases of dilated cardiomyopathy recover even in absence of reversible factors. Finally, these conditions represent paradigms of cardiac recovery suggesting a number of molecular mechanisms, which might be exploited in other cardiac conditions that are at present progressive and unresponsive to therapy.…”

Role of Thyroid Hormones in Different Aspects of Cardiovascular System

“…TMC is defined as secondary ventricular dysfunction due to chronic tachycardia, which is fully or partially recoverable after heart rate normalization; the diagnosis should be suspected in patients with compromised ventricular function in the course of a ventricular or supraventricular tachycardia. The diagnosis can only be established with the recovery of ventricular function once the tachycardia and the thyrotoxic state are under control [37,38]. While TMC usually presents with significant cardiac enlargement, reduced ventricular wall thickness, and impaired ventricular contraction similar to dilated cardiomyopathy, the cardiac abnormalities normalize with control of the tachyarrhythmia and heart failure.…”