Arrhythmia-induced cardiomyopathy: focus on atrial fibrillation

Area of Science:

• Cardiology
• Electrophysiology
• Heart Failure Research

Background:

• Arrhythmias and heart failure (HF) are leading causes of global morbidity and mortality.
• Patients with both conditions exhibit particularly poor prognoses.
• Arrhythmia-induced cardiomyopathy (AIC) results from arrhythmias, frequently atrial fibrillation (AF), causing or exacerbating HF.

Purpose of the Study:

• To review the pathophysiological mechanisms of AIC, focusing on AF.
• To discuss the epidemiology, clinical presentation, and assessment of AIC.
• To outline the therapeutic strategies for suspected AIC, emphasizing rhythm control.

Main Methods:

• Literature review focusing on pathophysiological mechanisms of AIC.
• Analysis of epidemiological data and clinical presentations.
• Discussion of diagnostic and therapeutic approaches for AIC.

Main Results:

• AIC is characterized by reversible left ventricular systolic dysfunction upon rhythm restoration.
• Distinguishing HF-induced arrhythmias from arrhythmia-induced HF is difficult, leading to underdiagnosis of AIC.
• Restoring sinus rhythm is key to diagnosing AIC and requires concurrent HF management.

Conclusions:

• AIC diagnosis and management are hampered by challenges in differentiating causal relationships between arrhythmias and HF.
• Rhythm-control therapy is underutilized, contributing to AIC underdiagnosis.
• Objective parameters are urgently needed for accurate AIC identification.