Tachycardia-induced cardiomyopathy: mechanisms of heart failure and clinical implications

Calò, Leonardo; Ruvo, Ermenegildo De; Sette, Antonella; Sciarra, Luigi; Scioli, Roberto; Sebastiani, Francesco; Topai, Marco; Iulianella, Renzo; Navone, Giovanna; Lioy, Ernesto; Gaïta, Fiorenzo

doi:10.2459/01.jcm.0000260841.30415.62

Cited by 44 publications

(38 citation statements)

References 52 publications

(47 reference statements)

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“…However, a variety of supraventricular and ventricular tachyarrhythmias are thought to be reversible causes of DCM, and are referred to as tachycardia induced cardiomyopathy (TIC). [1][2][3] PVC is the most commonly encountered tachyarrhythmia in clinical practice. Although reports on the long-term outcomes of frequent PVCs have been inconsistent, [4][5][6][7] chronic frequent PVCs have recently been reported to be associated with ventricular dilatation and deterioration of ventricular systolic function, and have been suggested to be a potential cause of DCM with uncertain etiology.…”

Section: Discussionmentioning

confidence: 99%

Chronic Frequent Premature Ventricular Complexes Originating From Right and Non-Right Ventricular Outflow Tracts Change in Left Ventricular Function After Radiofrequency Catheter Ablation

et al. 2010

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SummaryFrequent premature ventricular complexes (PVCs) from the right ventricular outflow tract (RVOT) have recently been reported to be a cause of dilated cardiomyopathy. We studied the clinical impact of the elimination of PVCs from RVOT and non-RVOT.Thirty-six patients with symptomatic PVCs that were treated with radiofrequency catheter ablation (RFCA) were studied. The patients were assigned to one of two groups according to the origin of the PVCs (group I, RVOT-origin, n = 24; group II, non-RVOT-origin, n = 12) and observed for 10.5 ± 7.1 months.The burden of PVCs at baseline was 19.7 ± 10.6% and 18.7 ± 8.7% in group I and group II, respectively (P = 0.779). In group II, hypertension was more common (16.7% versus 58.3%, P = 0.020) and LV diastolic function was worse (Em, 8.7 ± 3.0 versus 6.4 ± 1.8 cm/second, P = 0.018). The LV end diastolic volume index (LVEDVI) decreased in both groups (59.7 ± 14.6 to 50.9 ± 9.6 mL/m 2 , P = 0.004 in group I; 60.0 ± 19.9 to 51.6 ± 12.4 mL/m 2 , P = 0.044 in group II), while the left atrial volume index (LAVI) decreased only in group I (36.7 ± 11.7 to 31.7 ± 10.0 mL/m 2 , P = 0.002 in group I; 35.6 ± 11.9 to 33.8 ± 10.3 mL/m 2 , P = 0.317 in group II). The left ventricular ejection fraction (LVEF) significantly improved in both groups (51.1 ± 6.6 to 59.8 ± 7.2 %, P < 0.01 in group I; 49.9 ± 6.9 to 59.0 ± 5.9 %, P < 0.01 in group II).RFCA of PVCs leads to a reduction of LV volume and improvement of LV systolic function regardless of the origin of the PVCs. Conversely, a non-RVOT-origin as well as an RVOT-origin of the PVCs can cause DCM-like changes in the left ventricle. (Int Heart J 2010; 51: 388-393)

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Section: Discussionmentioning

confidence: 99%

Chronic Frequent Premature Ventricular Complexes Originating From Right and Non-Right Ventricular Outflow Tracts Change in Left Ventricular Function After Radiofrequency Catheter Ablation

et al. 2010

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“…TMC develops gradually over months or years [4]. As measured by the left ventricular ejection fraction, it is partially, if not completely, reversible after correction of tachycardia, especially if the tachycardia is transient [4][5][6][7][8].…”

Section: What Is Tachycardia-mediated Cardiomyopathy?mentioning

confidence: 99%

Tachycardia-mediated cardiomyopathy: Recognition and management

Gopinathannair¹,

Sullivan²,

Olshansky

2009

Curr Heart Fail Rep

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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.

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“…33 Uncontrolled ventricular rates have multiple adverse effects such as worsening of symptoms, decrease in stroke volume and development of tachycardia-induced cardiomyopathy and congestive heart failure. 65,66 In the AFFIRM trial, adequate rate control was defined as an average heart rate ≤80 beats per minute (bpm) at rest and a maximum heart rate ≤110 bpm during either a six-minute walk or moderate exercise, 19 whereas the standard for rate control in the RACE trial was more lenient, requiring only a resting heart rate <100 bpm. Analyses of the RACE and the AFFIRM trials suggested that the subgroup of patients with resting heart rates above 100 bpm had worse outcomes compared with patients with slower rates, but it was not clear whether this was due to the impact of better rate control, or reflected co-morbidities resulting in both higher heart rates and worse outcomes.…”

Section: Targets For Rate Controlmentioning

confidence: 99%

Current Evidence and Recommendations for Rate Control in Atrial Fibrillation

Maan¹,

Mansour²,

Ruskin³

et al. 2013

Arrhythmia &Amp; Electrophysiology Review

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Atrial fibrillation (AF) is the most common cardiac arrhythmia encountered in clinical practice.1 It has been estimated that >3 million people in the US and >4.5 million in the EU have paroxysmal or persistent AF.2-4 AF is associated with an approximately fivefold increased risk of stroke, 5 threefold risk of heart failure, 6 diminished quality of life 7 and increased healthcare costs. 8,9 Ventricular rate control strategy has been a traditional front-line and well-tolerated therapeutic option for the management of patients with AF.Although seemingly preferable in terms of potential advantages related to improved cardiac function and avoidance of unfavourable atrial electrical and mechanical remodelling, the currently available trial and other studies on the utility of dronedarone as a newer antiarrhythmic agent also suggest its limited efficacy and significant potential for adverse events. 11-13Catheter ablation, although generally superior to antiarrhythmic drug therapy in achieving SR, still remains limited by non-trivial recurrence rates for AF as well as the potential for procedural complications and the lack of currently available data on very long-term efficacy and mortality. [14][15][16][17][18] In the meantime, it continues to be an area of intensive research in terms of its role as an evolving therapeutic option to achieve sinus rhythm.In this review article we aim to discuss recommendations for ventricular rate control strategy in the management of patients with AF based on currently available data and the relevance of a rhythm control strategy with the advent of recent treatment advances in the field of antiarrhythmic drug therapy and catheter ablation. Rate ControlVentricular rate control has been an area of continuous investigation over the years. Until the results of Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) trial were published, rhythm control was widely believed to be a superior therapy with the rationale of SR being associated with better exercise tolerance, superior symptom control and possible decrease in morbidity (see Figure 1). 19 Despite these potential benefits of rhythm control, rate control was found to be non-inferior to rhythm control in the AFFIRM trial, with a trend toward reduced mortality with rate control. Results AbstractAtrial fibrillation (AF) is the most common cardiac arrhythmia encountered in clinical practice, which is associated with substantial risk of stroke and thromboembolism. As an arrhythmia that is particularly common in the elderly, it is an important contributor towards morbidity and mortality. Ventricular rate control has been a preferred and therapeutically convenient treatment strategy for the management of AF.Recent research in the field of rhythm control has led to the advent of newer antiarrhythmic drugs and catheter ablation techniques as newer therapeutic options. Currently available antiarrhythmic drugs still remain limited by their suboptimal efficacy and significant adverse effects. Catheter ablation as a newer modality...

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Tachycardia-induced cardiomyopathy: mechanisms of heart failure and clinical implications

Cited by 44 publications

References 52 publications

Chronic Frequent Premature Ventricular Complexes Originating From Right and Non-Right Ventricular Outflow Tracts Change in Left Ventricular Function After Radiofrequency Catheter Ablation

Chronic Frequent Premature Ventricular Complexes Originating From Right and Non-Right Ventricular Outflow Tracts Change in Left Ventricular Function After Radiofrequency Catheter Ablation

Tachycardia-mediated cardiomyopathy: Recognition and management

Current Evidence and Recommendations for Rate Control in Atrial Fibrillation

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