Reversible cardiomyopathy-tachycardiomyopathy in children

Abstract

Tachycardia-induced cardiomyopathy (tachycardiomyopathy) is defined by the presence of a sustained tachycardia that results in left ventricular systolic dysfunction. Restoration of cardiac function is dependent on the control of tachyarrhythmias. We report a series including ten children with tachycardia-induced cardiomyopathy with different etiologies. The medical records of patients with tachycardiomyopathy who were managed in a Pediatric Cardiology Clinic between the years of 2014-2017 were reviewed retrospectively. Ten children (3 female, 7 male) were diagnosed with tachycardiomyopathy. The median age of the patients was 12 years (range: 4-15.8). Five had atrial tachycardia, two had ventricular tachycardia, the others had Mahaim fiber tachycardia, permanent junctional reciprocating tachycardia and atrioventricular reentrant tachycardia. Seven patients had catheter ablation and three patients who had previous heart surgery were treated with antiarrhythmic drugs. Median ejection fraction was 33% (range: 10-48), median left ventricle end-diastolic diameter was 55 mm (range: 30-78). All showed complete recovery with median ejection fraction 60% (range: 55-78). Two patient with severe heart failure required extracorporeal membrane oxygenation support, one of them had ventricular assist device support but the device was removed after successful ablation. After two years this patient required permanent pacemaker implantation due to complete atrioventricular block. Tachycardia-induced cardiomyopathy is a rare and treatable cause of heart failure. Early recognition is critical, aggressive treatment aimed at controlling the arrhythmia results in symptom resolution and recovery of ventricular function.

Clinical Profile and Predictors of Outcome in Children with Acute Fulminant Myocarditis Receiving Intensive Care: A Single Center Experience

“…It has also been shown that many children with tachyarrythmia tend to have antecedent history of infection and nonspecific symptoms such as dyspnea, palpitation, and cough which mimic diagnosis of myocarditis and DCM. 18 The improvement in cardiac function over time with normalization in heart rate is diagnostic of tachycardiomyopathy. The median time recovery of cardiac function in tachycardia induced cardiomyopathy is <2 months 19 Children with SVT in our series had features of myocardial dysfunction in the form of cardiomegaly, shock, reduced EF, and raised CK-MB.…”

Emerging concepts in heart failure management and treatment: focus on tachycardia-induced cardiomyopathy

“…Once HR is normalized (for example, medical treatment, electrical cardioversion and radiofrequency ablation), the clinical and functional recovery of the heart is rapid and does not usually extend beyond 6 months. 1 , 18 , 40 However, the possibility of recurrence 1 , 2 , 66 exists (unusual in children 42 ) possibly linked to the persistence of interstitial fibrosis regardless of LVEF improvement. 43 , 44 …”

“… 6 , 35 , 38 Once control of tachyarrhythmia is effective, the greatest improvement in LVEF is found during the first month, whilst its complete recuperation can extend to the second or third month (in general, not more than 6 months). 1 , 18 , 41 It has also been observed that patients who present a more significant improvement are those with a worse pre-treatment LVEF 42 whilst, in children, TCMP typically makes a complete recovery with appropriate treatment. 1 , 43 …”

Successful Explantation of Berlin Heart Excor in Two Young Children

“…Management of TIC is directed towards the control of the arrhythmia either by rate control or return to sinus rhythm which can be achieved through cardioversion, antiarrhythmic drugs, and/or catheter ablation. 9 Heart failure management can be also required in selected cases of incessant arrhythmias which are generally related to the longer duration of the tachycardia. In patients with TIC, ECMO can be used during the initial management of critically ill patients presenting in cardiogenic shock.…”