Severe and Reversible Left Ventricular Dysfunction Due to Slow Atrial Tachycardia Masquerading as Sinus Tachycardia

Arrhythmia-induced cardiomyopathy is a reversible cause of heart failure but is often underrecognized, particularly with subtle or slow atrial tachycardia (AT) with 1:1 atrioventricular conduction.

A 55-year-old man with prior mitral valve surgery and dual-chamber implantable cardioverter-defibrillator presented with fatigue and dyspnea. Echocardiography revealed ejection fraction decline from 40% to 45% to 20% to 25%. Device interrogation suggested abnormal atrial histograms. Electrophysiological study confirmed slow AT (tachycardia cycle length: 600-630 milliseconds), and activation mapping demonstrated a microreentrant circuit near the mitral valve. Radiofrequency ablation terminated the arrhythmia, and ejection fraction returned to baseline within weeks.

Slow AT can masquerade as sinus tachycardia and cause reversible left ventricular dysfunction. Recognition relies on device diagnostics and careful electrophysiological evaluation. Autonomic imbalance and incessant tachycardia are key pathophysiological mechanisms.

Early identification and ablation of slow AT can restore cardiac function and prevent progression to advanced heart failure therapies.