The clinical, electrocardiographic and echocardiographic characteristics and long-term outcome of patients with tachycardia-induced cardiomyopathy

Abstract

IntroductionThe clinical, electrocardiographic and echocardiographic features and long-term outcome of patients with tachycardia-induced cardiomyopathy (TIC) have not been well described in the past.MethodsA retrospective study was performed at our institution of patients with a diagnosis of TIC.ResultsThirty-three patients with pure TIC and 12 patients with impure TIC were identified. Compared to patients with dilated cardiomyopathy (DCMO), pure TIC patients were less symptomatic, as judged by NYHA class (p = 0.02), they had fewer clinical signs of heart failure (p = 0.007) and were more likely to report palpitations (p = 0.007) at presentation. Electrocardiographically, pure TIC patients had fewer Q waves (p = 0.002), less left ventricular hypertrophy (LVH) (p = 0.004) and repolarisation abnormalities (p = 0.048), and shorter QRS durations (p = 0.024). Echocardiographically, pure TIC patients had significantly smaller left ventricular internal diameter in diastole (LVIDd) (p < 0.001), ventricular internal diameter in systole (LVIDs) (p = 0.001) and left atrial dimensions (p = 0.048) at presentation compared to DCMO patients. Patients with pure TIC had a trend towards increased residual LVIDd dimensions compared to a control group with normal echocardiograms, indicating a persistence of adverse LV remodelling late after control of the causative tachycardia (p = 0.06). Recurrent tachycardia occurred in three patients, which resulted in a precipitous decline in left ventricular ejection fraction (LVEF).ConclusionsThis study is the first to compare features of pure and impure TIC. Patients with pure TIC had shorter QRS durations, fewer Q waves, and less LVH and repolarisation abnormalities at presentation compared to DCMO patients. TIC patients tended to have smaller LVIDd dimensions at presentation and have persistence of adverse LV remodelling, as characterised by persistent enlargement of LVIDd dimensions, at late follow up.

Diffuse Ventricular Fibrosis Is a Late Outcome of Tachycardia-Mediated Cardiomyopathy After Successful Ablation

“…In contrast, the majority of patients in previous TMC series have had cardiomyopathy secondary to atrial fibrillation/flutter. [7][8][9]21 In these series, outcomes may have been negatively biased by the presence of conditions associated with these arrhythmias such as preexisting hypertension and heart failure. Cases of atrial fibrillation were generally treated with pharmacological rate-control or cardioversion, allowing the confounding influence of arrhythmia recurrence and unrecognized periods of poor rate-control to bias results.…”

“…[3][4][5] Successful rate or rhythm control results in normalization of ejection fraction (EF) within weeks to months in the absence of concurrent causes of cardiomyopathy. 1,[6][7][8] …”

Role of the Electrophysiologist in the Treatment of Tachycardia-Induced Cardiomyopathy

“…Chin et al [16] reported a series of patients who had improvement of the ejection fraction after 6 months of rate control: two patients with atrial fibrillation treated for heart rate control, two patients with atrial tachycardia treated for heart rate control and two patients with severe systolic dysfunction EF < 20% and recovery of systolic function after adequate treatment. The "slower" the rate control of the tachycardia, the slower the rate of improvement of the systolic function of the left ventricle.…”

“…In contrast, patients with very low ejection fraction <20% have a slower rate of improvement. Chin et al evaluated systolic function using either echocardiography or radionuclide angiography [16]. Danadamudi et al reported patients with ejection fraction normalization after 14 months, but elevated left ventricular end-systolic and enddiastolic volume indexes were still present at follow-up.…”

Senam Aerobik Low Impact dapat Menurunkan Tekanan Darah pada Lansia dengan Hipertensi

“…16 Olahraga aerobik low impact merupakan olahraga yang tepat di lakukan oleh lansia terutama yang mengalami hipertensi salah satunya yaitu senam aerobik. (6) Senam yang dilakukan oleh lansia yaitu senam yang meggunakan gerakan ringan, intensitas sedang, mudah dilakukan dan menghindari gerakan loncat-loncat yang disebut dengan low impact. Gerakan ini dapat memacu kerja jantung dengan intensitas ringan sedang, bersifat menyeluruh dengan gerakan yang melibatkan sebagai besar otot tubuh serasi sesuai gerak sehari-hari.…”