Arrhythmia-Induced Cardiomyopathies

Abstract

Arrhythmia-induced cardiomyopathy (AIC) is a potentially reversible condition in which left ventricular dysfunction is induced or mediated by atrial or ventricular arrhythmias. Cellular and extracellular changes in response to the culprit arrhythmia have been identified, but specific pathophysiological mechanisms remain unclear. Early recognition of AIC and prompt treatment of the culprit arrhythmia using pharmacological or ablative techniques results in symptom resolution and recovery of ventricular function. Although cardiomyopathy in response to an arrhythmia may take months to years to develop, recurrent arrhythmia can result in rapid decline in ventricular function with development of heart failure, suggesting residual ultrastructural abnormalities. Reports of sudden death in patients whose left ventricular ejection fraction have normalized cast doubt on the complete reversibility of this condition. Several aspects of AIC, including specific pathophysiological mechanisms, predisposing factors, optimal therapeutic strategies to prevent ultrastructural changes, and long-term risk of sudden death remain unresolved and need further research.

The detrimental potential of arrhythmia‐induced cardiomyopathy

“…Diagnostic criteria for AIC are unexplained LVSD with concomitant arrhythmia and partial or complete recovery of LV function after restoration of sinus rhythm 1, 2. In the present case, these criteria were fulfilled and alternative causes of LVSD were carefully ruled out.…”

“…This case report demonstrates that severe LVSD can be caused by AIC and may eventually lead to multiple organ failure 1, 5. Diagnostic criteria for AIC are unexplained LVSD with concomitant arrhythmia and partial or complete recovery of LV function after restoration of sinus rhythm 1, 2.…”

“…Conclusively, diagnosis of AIC was confirmed after restoration of sinus rhythm and early improved LV function within days to weeks. Nevertheless, it is well accepted that full recovery of LV function may last from weeks to months up to more than a year 1. Importantly, rhythm control and subsequent increment of LV function also resulted in a fast recovery of the other compromised organ functions, illustrating the closed connection of the liver, kidney, and AIC.…”

“…Although typical atrial flutter as it occurs in this case report is rarely caused by LVSD, AIC generally raises a ‘chicken or egg’ question. Frequently, the arrhythmia is considered secondary and is not treated effectively when, in fact, arrhythmia control may be necessary for recovery of LV function 1. Accordingly, AIC appears to be an underestimated cause of LVSD.…”

“…Arrhythmia‐induced cardiomyopathy (AIC) represents a potentially reversible condition of left‐ventricular (LV) systolic dysfunction (LVSD), which is caused by atrial or ventricular tachycardia/arrhythmias 1, 2. As rhythm disorders are often regarded as consequences of LVSD in daily clinical practice, AIC appears to be an underestimated cause of heart failure, particularly when ‘idiopathic dilated cardiomyopathy’ with concomitant arrhythmia is diagnosed.…”