Review
Tachycardia-induced cardiomyopathy

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Abstract

Systolic dysfunction associated with chronic tachyarrhythmias, known as tachycardia-induced cardiomyopathy, is a reversible form of heart failure characterized by left ventricular dilatation that is usually reversible once the tachyarrhythmia is controlled. Its development is related to both atrial and ventricular arrhythmias. The diagnosis is usually made following observation of a marked improvement in systolic function after normalization of heart rate. Clinicians should be aware that patients with unexplained systolic dysfunction may have tachycardia-induced cardiomyopathy, and that controlling the arrhythmia may result in improvement and even complete normalization of systolic function.

Section snippets

Pathophysiology

Animal studies, particularly in dogs and pigs, have demonstrated that the progression and reversal of heart failure depend on the heart rate, and the duration and type of tachycardia. Sustained rapid atrial or ventricular pacing in animals results in systolic heart failure that is neurohormonally and hemodynamically similar to left ventricular systolic failure in humans 5, 6, 7, 8, 27. Hemodynamic alterations include elevated ventricular filling pressures, severe biventricular systolic

Clinical features and diagnostic considerations

Tachycardia-induced cardiomyopathy occurs in association with supraventricular tachyarrhythmias, such as atrial fibrillation 10, 13, 16, 39, 40, 41, 42, 43, 44, atrial flutter 20, 21, automatic atrial tachycardia 17, 18, 19, 45, 46, atrioventricular nodal re-entry tachycardia (22), automatic atrioventricular junctional tachycardia (23), and accessory pathway tachycardia (24), as well as with ventricular tachycardia 25, 26, 47, 48, 49, 50. In animal models, ventricular tachyarrhythmias cause a

Treatment

There is ample evidence that restoration of a normal heart rate improves left ventricular systolic function and reverses clinical manifestations of heart failure in patients with tachycardia-induced cardiomyopathy. Thus, the cornerstone in the management of these patients is to achieve normal heart rates. The best means to achieve heart rate control vary depending on the type of arrhythmia, and are outside the scope of this review.

Most of the available data relates to patients with atrial

Conclusion

Tachycardia-induced cardiomyopathy is a reversible form of dilated cardiomyopathy and heart failure caused by supraventricular and ventricular tachyarrhythmias. Its diagnosis requires a high index of suspicion, and the clinician should consider the diagnosis in patients with unexplained systolic dysfunction and any form of tachyarrhythmia. Heart rate normalization, by either rate or rhythm control, is the cornerstone of therapy, which may result in improvement or normalization of systolic

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      Atrial fibrillation itself has an undesirable impact on atrial electrophysiology, and both atrial and ventricular function. In terms of the latter, the most important of the several factors that may adversely impact left ventricular function are the impact of sustained, inappropriately high heart rates on the ventricle (the concept of so-called “tachycardia-mediated cardiomyopathy”),74–76 and the potential for repetitive coronary artery embolism. Abnormal intra-atrial conduction (eg, prolonged and/or complex appearing P wave), and, in some cases, disturbances of AV conduction (eg, atrial fibrillation with a slow ventricular response not due to drug therapy) fall within the SND landscape.

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