Successful Reversal of Severe Tachycardia-Induced Cardiomyopathy with Cardiogenic Shock by Urgent Rhythm or Rate Control: Only Rhythm and Rate Matter

Background and objectives Severe forms of Tachycardia-induced cardiomyopathy (TIC) with cardiogenic shock are not well described so far, and efficiency of catheter ablation in this setting is unknown. Methods We retrospectively included consecutive patients admitted to the Intensive Cardiac Care Unit for acute heart failure with cardiogenic shock associated with atrial arrhythmia and managed by ablation. Result Fourteen patients were included, each with cardiogenic shock and two needing the use of extracorporeal membrane oxygenation. Successful ablation was performed in the acute setting or over the following weeks. Two patients experienced relapses of arrhythmias and were treated by new ablation procedures. At 7.5 ± 5 months follow-up, all patient were alive with stable sinus rhythm. The left ventricular Ejection Fraction dramatically improved (21 vs. 54%, p = 0.001) as well as the end-diastolic left ventricular diameter (61 vs. 51 mm, p = 0.01) and NYHA class (class IV in all vs. median 1, p = 0.002). Conclusion Restoration and maintenance of sinus rhythm in severe TIC with cardiogenic shock and atrial arrhythmias lead to a major increase or normalization of LVEF, reduction of ventricular dimensions, and improvement in functional status. Ablation is efficient in long-term maintenance of sinus rhythm and may be proposed early in refractory cases.

Ivabradine-sensitive incessant atrial tachycardia during pregnancy: a case report

Background Automaticity is the dominant mechanism in maternal focal atrial tachycardia (FAT) during pregnancy and if incessant, can cause tachycardia-induced cardiomyopathy. Medication failure for FATs is common, however, for the subgroup due to increased automaticity ivabradine sensitivity has been described and may represent a valuable treatment option. Little data are available regarding the safety profile of ivabradine during pregnancy. Case Summary We report the case of a 38-year-old woman with background of peripartum cardiomyopathy and incessant atrial tachycardia with deteriorating ventricular function during her second pregnancy unresponsive to betablockade and demonstrating the immediate successful rate-controlling effect of ivabradine. Discussion Early recognition of persistent maternal FAT is essential due to its frequent association with tachycardia-mediated cardiomyopathy. Our case report highlights the challenges of providing an equally safe and effective treatment of these notoriously difficult to treat arrhythmias during pregnancy. Ivabradine in combination with a betablocker can be effective for abnormal automaticity but its safety profile during pregnancy remains uncertain.

Idiopathic Atrial Flutter Associated with Dilated Cardiomyopathy in a Preterm Newborn: A Case Report

<b><i>Background:</i></b> Arrhythmias in neonates are uncommon and usually affect newborns with a normal heart or associated with structural heart disease. Meanwhile, one uncommon type of supraventricular arrhythmias is atrial flutter (AF), which is reentry mechanisms in the atrium. The AF may result in heart failure or even death, but the majority of its cases have revealed favorable prognosis in the event of early prenatal diagnosis and immediate treatment [J Am Coll Cardiol. 2006;48:1040–6, Semin Fetal Neonatal Med. 2006;11:182–90, and Arch Argent Pediatr. 2007;105:427–35]. A persistent tachyarrhythmia can progress to a state of cardiac dysfunction known as tachycardia-induced cardiomyopathy. While this may be a rare cause of dilated cardiomyopathy and heart failure in children, the condition is usually reversible and should be considered in newborn and infants [Europace. 2011;14(4):466–473]. <b><i>Case Report:</i></b> A preterm 33+1-week male newborn with birth weight 2,790 g was delivered through cesarean section. The baby presented with tachycardia after birth associated with respiratory distress. The physical examination showed heart rate &#x3e;220/min, and ECG showed “saw tooth pattern” after intravenous adenosine boluses confirming diagnosis of AF (2-3:1). The heart rate reverted to sinus rhythm after synchronized cardioversion. Due to poor LV myocardial performance with dilated chambers, the baby received intravenous milrinone, followed by oral captopril. The baby was discharged on oral medications in perfect clinical condition, and follow-up showed no recurrence AF with improved cardiac function. <b><i>Conclusion:</i></b> Despite the rare occurrence, AF should be considered in differential diagnosis of newborn arrhythmia and diagnosed after intravenous adenosine injection. In few cases, AF can be associated with dilated cardiomyopathy which is a reversible condition.

The Challenges of Tachycardia Induced Cardiomyopathy - a Case Report

Tachycardia-induced cardiomyopathy (TIC) is characterized by reversible left ventricular dysfunction caused by long-standing tachycardia. Treatment options for tachyarrhythmias causing TIC have evolved, especially the rhythm control strategies, ensuring a better and more sustainable control of the arrhythmia. We report the case of a 46-year-old male presenting with acute heart failure, atrial fi brillation (AF) of unknown duration and severe left ventricular dysfunction, as well as left ventricular dilation. His medical history was relevant for atrial fl utter treated with catheter ablation, hypertension, and frequent atrial ectopy for which he had been prescribed amiodarone. Coronary artery disease and other potential causes for left ventricular dysfunction were excluded with coronary angiography and cardiac magnetic resonance. Thus, the patient had a high suspicion of TIC. We opted for a rhythm control strategy, however, after a successful initial electrical cardioversion, he had AF recurrence a few days later, under classic heart failure medication and antiarrhythmics. Pulmonary vein isolation was then performed, with no complications. At the one-month follow-up visit the patient was arrhythmia-free and had a normal left ventricular ejection fraction, with a slightly enlarged left ventricle. We opted to continue the heart failure medication. This case illustrates a typical case of AF induced TIC and the limited pharmacological options that exist for rhythm control, as well as the high efficacy of catheter ablation and value of imaging.

Tachycardia-Induced Cardiomyopathy

Tachycardia-induced cardiomyopathy (TIC) is characterized by reversible left ventricular (LV) dysfunction caused by long-standing tachycardia. The diagnosis of TIC is challenging due to lack of guidelines and specific assessment tools. Advanced imaging and endomyocardial biopsy should be taken into consideration in the future as contributors in the diagnostic process. There are numerous unknowns to TIC, the most pressing being the lack of diagnostic and prognostic tools. The presence of persistent negative LV remodeling after the normalization of the LV ejection fraction with adequate treatment of the tachycardia gives us a glimpse into the complex pathophysiologic processes at play, as well as the disease prognosis.

usefulness of the electrocardiogram and cardiac magnetic resonance to differentiate tachycardia induced cardiomyopathy from dilated cardiomyopathy in patients admitted for heart failure

Funding Acknowledgements Type of funding sources: None. Background In patients admitted for heart failure (HF) with reduced left ventricular ejection fraction (LVEF) and a concomitant high-rate supraventricular tachyarrhythmia (SVT) it is challenging to predict LVEF recovery after heart rate control and distinguish tachycardia-induced cardiomyopathy (TIC) from dilated cardiomyopathy (DC). The role of cardiac magnetic resonance (CMR) and the electrocardiogram (ECG) in this setting remains unsettled. Methods Forty-three consecutive patients admitted for HF due to high-rate SVT and LVEF &lt;50% undergoing CMR in the acute phase were retrospectively included. Those who had LVEF &gt;50% at follow up were classified as TIC and those with LVEF &lt;50% were classified as DC. Clinical, laboratory, CMR and ECG findings were analyzed to predict LVEF recovery. Results Twenty-five (58%) patients were classified as TIC. Patients with DC had wider QRS (121.2 ± 26 vs 97.7 ± 17.35 ms; p = 0.003). On CRM the TIC group presented with higher LVEF (33.4 ± 11 vs 26.9 ± 6.4% p = 0.019) whereas late gadolinium enhancement (LGE) was more frequent in DC group (61 vs 16% p = 0.004). On multivariate analysis, QRS duration ≥100 ms (p = 0.027), LVEF &lt; 40% on CMR (p = 0.047) and presence of LGE (p = 0.03) were identified as independent predictors of lack of LVEF recovery. Furthermore, during clinical follow-up (median 60 months) DC patients were admitted more frequently for HF (44% vs 0%; p &lt; 0.001) than TIC patients (Figure 1). Conclusion In patients with reduced LVEF admitted for HF due to high-rate SVT, QRS duration ≥100 ms, LVEF &lt;40% on CMR and presence of LGE are independently associated with lack of LVEF recovery and worse clinical outcome.

Tachicardia-induced cardiomyopathy. Case report

The tachycardia-induced cardiomyopathy is a rare case of reversible heart failure and left ventricle disfunction. The diagnostic approach and treatment strategy are described in this article. Also the clinical case of heart failure compensation in the patient with left ventricle dilatation and atrial flutter after the reverse to sinus rhythm is after catheter ablation presented.