Published online before print June 28, 2004, doi: 10.1161/01.CIR.0000135472.28234.CC
(Circulation. 2004;110:247-252.)
© 2004 American Heart Association, Inc.
Original Articles |
Heart Failure and Sudden Death in Patients With Tachycardia-Induced Cardiomyopathy and Recurrent Tachycardia
From the University of Iowa Hospitals, Iowa City, and Loyola University Medical Center, Maywood, Ill.
Correspondence to Brian Olshansky, MD, Director, Cardiac Electrophysiology, University of Iowa Hospital, 200 Hawkins Dr, Iowa City, IA 52242–1081. E-mail brian-olshansky{at}uiowa.edu
Received May 13, 2003; de novo received February 8, 2004; revision received March 23, 2004; accepted March 29, 2004.
Background— Tachycardia-induced cardiomyopathy is a reversible cause of heart failure. We hypothesized that although left ventricular ejection fraction measurements normalize after heart rate or rhythm control in patients with tachycardia-induced cardiomyopathy, recurrent tachycardia may have abrupt and deleterious consequences.
Methods and Results— Patients with tachycardia-induced cardiomyopathy that developed over years were evaluated and treated. Tachycardia episodes and outcomes were assessed. Twenty-four patients were identified. All had NYHA functional class III heart failure or greater on presentation. One third were heart transplant candidates. There were 17 men and 7 women with a mean age of 46±16 years and mean left ventricular ejection fraction of 0.26±0.09 at the index visit. The cause was atrial fibrillation (n=13), atrial flutter (n=4), atrial tachycardia (n=3), idiopathic ventricular tachycardia (n=1), permanent junctional reciprocating tachycardia (n=2), and bigeminal ventricular premature contractions (n=1). Within 6 months of rate control or correction of the rhythm, left ventricular ejection fraction improved or normalized and symptoms abated in all. Five patients had tachycardia recur. In these patients, left ventricular ejection fraction dropped precipitously and heart failure ensued within 6 months, even though the initial impairment took years. Rate control eliminated heart failure and improved or normalized ejection fraction in 6 months. Three of 24 patients died suddenly and unexpectedly.
Conclusions— Tachycardia-induced cardiomyopathy develops slowly and appears reversible by left ventricular ejection fraction improvement, but recurrent tachycardia causes rapid decline in left ventricular function and development of heart failure. Sudden death is possible.
Key Words: arrhythmia • death, sudden • heart failure • heart rate • tachycardia
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