Tachycardia‐Induced Cardiomyopathy: Evaluation and Therapeutic Options

Lishmanov, Anton; Chockalingam, Priya; Senthilkumar, A.; Chockalingam, Anand

doi:10.1111/j.1751-7133.2010.00147.x

Cited by 40 publications

(37 citation statements)

References 32 publications

(112 reference statements)

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“…[3][4] With rapid ventricular rate, they often complain of easy fatigability and palpitation and eventually may have tachycardia-induced cardiomyopathy and heart failure. 5 There have been many recent advances in the field of AF including a new classification, clinical studies comparing rate and rhythm control treatment strategies, and development of risk stratification algorithms to guide anticoagulation. 6 -8 Recent trials of new anticoagulant and new antiarrhythmic drugs are likely to influence future management guidelines.…”

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confidence: 99%

Gulf Survey of Atrial Fibrillation Events (Gulf SAFE)

Zubaid

Rashed

Alsheikh‐Ali

et al. 2011

Circ: Cardiovascular Quality and Outcomes

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Background— Atrial fibrillation (AF) is the most common serious cardiac arrhythmia, and its prevalence is expected to increase. There is lack of data about patient characteristics, practice patterns, and outcomes of AF in the Arab Middle East. Methods and Results— The Gulf Survey of Atrial Fibrillation Events (Gulf SAFE) is a prospective, observational registry of patients with AF with a 12-month follow-up. The registry was emergency room based. Between October 2009 and June 2010, 2043 consecutive patients with AF were enrolled from 23 hospitals in 6 Middle Eastern Gulf countries. Data were collected on a standardized case report form and entered online. Data collected included patient demographics, medical history, type of AF, treatment, and outcome of emergency room visit. If patients were admitted, details of their treatment, investigations, and outcomes during hospital stay were collected. Completion of 12-month follow-up is expected by July 2011. The mean age was 57 years, and 52% were men. The most common concomitant condition was hypertension, present in 1072 (52%) patients. At enrollment, 28% of patients had a history of coronary artery disease, 30% had diabetes, and 16% had rheumatic valve disease. History of stroke and transient ischemic attacks were reported in 9% and 4% of patients, respectively. The most common type of AF, first attack AF, occurred in 37%, whereas 19% of patients had lone AF. Conclusions— Gulf SAFE will provide valuable insights into AF management and outcomes in the Gulf region of the Middle East.

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confidence: 99%

Gulf Survey of Atrial Fibrillation Events (Gulf SAFE)

Zubaid

Rashed

Alsheikh‐Ali

et al. 2011

Circ: Cardiovascular Quality and Outcomes

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“…All these options are intended to restore normal heart rhythm as it improves ventricular function. [1,4,5] However, ventricular functional recovery is varying among patients after tachyarrhythmia is terminated or managed. [6] In this case, the patient had hemodynamically stable atrial fi-A B…”

Section: Discussionmentioning

confidence: 99%

“…The prevalence of arrhythmia for TC has not been established, patients with atrial fibrillation are most frequently reported. [1,2] In the absence of standard diagnostic criteria of TC, the physician needs to suspect TC in the presence of LV systolic dysfunction and sustained tachyarrhythmia. The ultimate goal of therapies for TC is to restore normal sinus rhythm.…”

Section: Discussionmentioning

confidence: 99%

Torsades de Pointes during Treatment of Tachycardia-Induced Cardiomyopathy

Lee

Ryu

Yoo

et al. 2014

Korean J Crit Care Med

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Tachycardia-induced cardiomyopathy is caused by persistent tarchyarrhythmias and is characterized by ventricular systolic dysfunction and congestive heart failure. Tachycardia-induced cardiomyopathy is usually reversible via treatment. The cornerstone in the management of disease in these patients is to achieve a normal heart rate. We report a torsades de pointes during treatment of tachycardia-induced cardiomyopathy. Intravenous magnesium sulfate and potassium were administrated, but torsades de pointes was repeated. After overdrive right ventricular pacing, torsades de pointes was terminated. Careful monitoring of the QT interval and serum electrolyte and drug levels in such patients is warranted during treatment of tachycardia-induced cardiomyopathy.brillation of more than 48-hours duration and systolic heart failure presumed to be caused by tachycardia-induced cardio-myopathy.As we checked no thrombus in left atrium and left atrial appendage using transesophageal echocardiography, pharmacological conversion to sinus rhythm was performed by using amiodarone in addition to heparin. However, the patient's atrial fibrillation was persistent for 24 hours despite drug therapy for restoration of sinus rhythm. Electrical cardioversion also failed to terminate atrial fibrillation. Then pharmacological intervention was instituted again for two days. In short, the patient was taking digoxin for the treatment of heart failure and given amiodarone additionally for conversion to sinus rhythm.According to the 2013 American Heart Association guidelines for atrial fibrillation treatment, the combination of digoxin and amiodarone or sotalol for conversion to sinus rhythm can have harmful effects.[7] However such a warning can be oversighted in the presence of severe systolic heart failure caused by TC as described in this case.Amiodarone is an effective class III antiarrhythmic drug that prolongs repolarization period and increases QT interval up to 20% from baseline QT interval. Like Class Ia antiarrhythmic drugs, amiodarone can prolong QT interval but it can also inhibit depolarization by acting on calcium channels. As a result, it is known to be safe compared to other antiarrhythmic drugs and its incidence rate of TdP is estimated at less than 1%. [8] However, the use of amiodarone in combination with digoxin increases the risk of arrhythmia. Especially, the onset of TdP is much more likely to occur within four days when amiodarone is administered. [9] Risk factors for TdP include women gender, myocardial infarction, heart failure, cardiomyopathy, valvular heart disease, the use of antiarrhythmic drugs, bradyarrhythmias, low serum potassium, low serum magnesium, and family history of QT interval prolongation.[10] Intravenous magnesium is considered standard therapy for the onset of TdP regardless of serum concentration. Serum potassium concentration should be maintained at upper limit of the normal range (4.5-5 mmol/L).Hemodynamically unstable patients may require an immediate defibrillation. If patients does not respond to...

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“…8 At least one quarter of patients with AF and left ventricular dysfunction have some degree of tachycardia-induced ventricular impairment. 9 The diagnosis of tachycardia-induced cardiomyopathy cannot be The decision to pursue restoration of sinus rhythm in patients with heart failure and concomitant AF is driven by the severity of AF-related symptoms and hemodynamic intolerance.…”

Section: Discussionmentioning

confidence: 99%

Atrial Fibrillation Through the Years

et al. 2013

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Forward Information about a real patient is presented in stages (boldface type) to an expert clinician (Dr Valentin Fuster), who responds to the information, sharing his reasoning with the reader (regular type). A discussion by the authors follows.A 61-year-old man presents with 2 weeks of exertional dyspnea. Pertinent medical history includes hypertension, nephrolithiasis, and internal hemorrhoids. He takes no medications and has no known drug allergies. His father died after a myocardial infarction at 57 years of age. He formerly smoked 1 pack of cigarettes daily for 15 years but ceased tobacco use 10 years before presentation. He ingests 2 glasses of alcohol weekly and denies illicit drug use. His caffeine intake is limited. He is an architect and is married, with healthy children.On physical examination, his temperature is 98.0°F, blood pressure is 130/85 mm Hg bilaterally, pulse is irregular at 130 beats per minute, and respiratory rate is 18 breaths per minute with an oxygen saturation of 97% while breathing room air. He is a slender white man in no distress. His jugular venous pressure is elevated at 14 cm H 2 O. There is no thyromegaly, and the carotid upstrokes are brisk, without bruits. Cardiovascular examination reveals a rapid and irregular heart rhythm with variation in the intensity of the first heart sound. The point of maximal impulse is not displaced. The remainder of the chest and abdominal examination is within normal limits. The extremities are warm and show mild pitting edema. Laboratory testing is significant for normal renal function and electrolytes, but a hemogram reveals a mild thrombocytopenia of 90 000 platelets/μL. ECG demonstrates atrial fibrillation (AF) with an average ventricular rate of 123 bpm (Figure 1). Dr Valentin Fuster:This is a patient with presumably nonvalvular AF presenting with a rapid ventricular rate. This is the patient's first detected episode of AF, and the duration of the arrhythmia, including previously undetected episodes, is unknown. The symptoms of AF may be subtle, and patients may become accustomed to limitations in exertional capacity.An attempt to elucidate common precipitants for AF, including alcohol consumption, emotional or physical stress, and sleep deprivation, is imperative. Physical examination in this patient suggests congestive heart failure with jugular venous distension and pitting edema. The ECG demonstrates the absence of organized atrial activity and corroborates the physical examination finding of an irregular ventricular rhythm.Initially, the priority is to address the presenting problem and control the patient's heart rate. This can be accomplished with β-blockade, which should be initiated in low doses and with careful monitoring given the risk of subsequent exacerbation of heart failure in patients with severe ventricular dysfunction. Although nondihydropyridine calcium channel antagonists could also be effective, they have negative inotropic effects and are better avoided in patients with heart failure. Digoxin, with its positive ino...

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Tachycardia‐Induced Cardiomyopathy: Evaluation and Therapeutic Options

Cited by 40 publications

References 32 publications

Gulf Survey of Atrial Fibrillation Events (Gulf SAFE)

Gulf Survey of Atrial Fibrillation Events (Gulf SAFE)

Torsades de Pointes during Treatment of Tachycardia-Induced Cardiomyopathy

Atrial Fibrillation Through the Years

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