Arrhythmia-Induced Cardiomyopathy: JACC State-of-the-Art Review

Area of Science:

• Cardiology
• Electrophysiology
• Heart Failure Research

Background:

• Arrhythmias frequently coexist with heart failure (HF) and left ventricular (LV) dysfunction.
• Certain arrhythmias, including tachycardias, atrial fibrillation, and premature ventricular contractions, can induce a reversible dilated cardiomyopathy known as arrhythmia-induced cardiomyopathy (AiCM).
• The reasons for varying susceptibility to AiCM among patients with similar arrhythmia burdens remain unclear.

Purpose of the Study:

• To investigate the role of arrhythmias in causing left ventricular dysfunction.
• To establish diagnostic criteria for AiCM.
• To outline therapeutic strategies and follow-up protocols for AiCM.

Main Methods:

• Clinical observation and diagnosis of patients with coexisting arrhythmias and LV dysfunction.
• Assessment of arrhythmia burden (e.g., mean heart rate >100 bpm, atrial fibrillation, premature ventricular contractions burden ≥10%).
• Confirmation of AiCM through reversal of cardiomyopathy after arrhythmia elimination.

Main Results:

• AiCM is a recognized cause of reversible LV dysfunction.
• Specific arrhythmia burdens and characteristics are associated with increased risk.
• Elimination of the causative arrhythmia leads to cardiomyopathy reversal.

Conclusions:

• Suspect AiCM in patients with significant arrhythmia burdens and LV dysfunction.
• Tailor therapeutic choices based on the specific arrhythmia, patient comorbidities, and preferences.
• Continued follow-up is essential for patients with underlying myocardial abnormalities post-recovery.