Tachycardia-induced cardiomyopathy: evolution of the concept and contemporary insights

Tachycardia-induced cardiomyopathy (TIC) is a reversible form of myocardial dysfunction caused by sustained or recurrent tachyarrhythmias. Despite increasing recognition, its diagnosis and management remain challenging in clinical practice. This review summarizes the historical evolution, epidemiology, pathophysiology, diagnosis, and management of TIC, and highlights current gaps in knowledge. Experimental and clinical studies have established that not only persistent tachycardia but also high arrhythmic burden and ventricular dyssynchrony contribute to myocardial dysfunction, leading to the broader concept of arrhythmia-induced cardiomyopathy (AiCM). Mechanistically, TIC involves neurohormonal activation, impaired calcium handling, energetic remodeling, oxidative stress, and microvascular dysfunction. Advances in understanding myocardial metabolism and reversibility have provided new insights into disease progression and recovery. However, in humans, the mechanisms underlying TIC/AiCM, as well as responsible for incomplete recovery of cardiac function, have not yet been fully elucidated. TIC is an underrecognized yet potentially reversible cause of heart failure. Early identification and appropriate control of the underlying arrhythmia are essential to improve outcomes. However, the lack of specific diagnostic markers and limited evidence for optimal management strategies remain significant challenges. Further research is needed to refine diagnostic approaches and develop targeted therapies.