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Clinical Characterization of Arrhythmia-Induced Cardiomyopathy in Patients With Tachyarrhythmia and Idiopathic
Christian Schach1, Thomas Körtl2, Florian Zeman3
1Universitäres Herzzentrum Regensburg, Klinik und Poliklinik für Innere Medizin II, Abteilung für Kardiologie, Universitätsklinikum Regensburg, Regensburg, Germany.
Insights
Arrhythmia-induced cardiomyopathy (AIC) is common in patients with unexplained heart dysfunction and fast heart rhythms. Early diagnosis may be possible using a smaller left ventricular end-diastolic diameter.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiomyopathy Research
Background:
- Arrhythmia-induced cardiomyopathy (AIC) is a recognized condition, yet prospective data on its characteristics are limited.
- Understanding AIC is crucial for patients with unexplained left ventricular systolic dysfunction (LVSD) and tachyarrhythmia.
Purpose of the Study:
- To determine the frequency of pure AIC in patients with newly diagnosed, unexplained LVSD and tachyarrhythmia.
- To assess the recovery timeline of LVSD after rhythm restoration.
- To identify early diagnostic markers for AIC.
Main Methods:
- Prospective patient inclusion with effective rhythm restoration.
- Follow-up at 2, 4, and 6 months, including clinical assessment, biomarkers, and cardiac MRI.
- Exclusion of patients with recurrent arrhythmias from the analysis.
Main Results:
- 41 out of 50 patients were diagnosed with AIC within 6 months post-rhythm restoration.
- Left ventricular ejection fraction significantly improved in AIC patients (35.4% to 52.7% at 2 months, and 57.2% at 6 months).
- Lower baseline left ventricular end-diastolic diameter was identified as a potential early diagnostic marker for AIC.
Conclusions:
- AIC is highly prevalent in patients with unexplained LVSD and tachyarrhythmia, suggesting it may be underdiagnosed.
- Rapid recovery from LVSD was observed in most AIC patients within months of rhythm restoration.
- A low initial LV end-diastolic diameter may serve as an early indicator for diagnosing AIC.
Background:
Arrhythmia-induced cardiomyopathy (AIC) is a known entity, but prospective evidence for its characterization is limited.
Objectives:
This study aimed to: 1) determine the relative frequency of the pure form of AIC in the clinically relevant cohort of patients with newly diagnosed, otherwise unexplained left ventricular systolic dysfunction (LVSD) and tachyarrhythmia; 2) assess the time to recovery from LVSD; and 3) identify parameters for an early diagnosis of AIC.
Methods:
Patients were prospectively included, underwent effective rhythm restoration, and were followed-up at 2, 4, and 6 months to evaluate clinical characteristics, biomarkers, and cardiac imaging including cardiac magnetic resonance imaging. Patients with recurred arrhythmia were excluded from analysis.
Results:
41 of 50 patients were diagnosed with AIC 6 months after rhythm restoration. Left ventricular (LV) ejection fraction increased 2 months after rhythm restoration from 35.4% ± 8.2% to 52.7% ± 8.0% in AIC patients vs 37.0% ± 9.5% to 43.3% ± 7.0% in non-AIC patients. From month 2 to 6, LV ejection fraction continued to increase in AIC patients (57.2% ± 6.1%; P < 0.001) but remained stable in non-AIC patients (44.0% ± 7.8%; P = 0.628). Multivariable logistic regression analysis revealed that lower LV end-diastolic diameter at baseline could be used for early diagnosis of AIC, whereas biomarkers and other morphological or functional parameters, including late LV gadolinium enhancement, did not show suitability for early diagnosis.
Conclusions:
We observed a high prevalence of AIC in patients with otherwise unexplained LVSD and concomitant tachyarrhythmia, suggesting that this condition may be underdiagnosed in clinical practice. Most patients recovered fast, within months, from LVSD. A low initial LV end-diastolic diameter may constitute an early marker for diagnosis of AIC.
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