Tachycardia-induced cardiomyopathy

Tachycardia-induced cardiomyopathy
Classification and external resources
Specialty cardiology
ICD-10 I42.9

Tachycardia-induced cardiomyopathy, also known as chronotropic cardiomyopathy and tachycardiomyopathy, is an impairment of the pumping efficiency of the myocardium (the muscle of the heart) due to prolonged periods of a fast heart rate or irregular heart rhythm.[1] It was first described by Phillips and Levine in 1949.[2] and can occur at any age.[3]

The rate and duration of the elevation in heart rate necessary to cause a cardiomyopathy is unclear and is likely dependent on a number of unknown factors.

The incidence of tachycardia induced cardiomyopathy (TIC) is unknown, and to this date, much of the understanding of this cardiomyopathy is based upon animal models.[4]

Epidemiology

The true incidence of tachycardia-induced cardiomyopathy is unclear.[5] Some studies have noted the incidence of tachycardia-induced cardiomyopathy in adults with adults with irregular heart rhythms to range from 8% to 34%.[5]

Signs and Symptoms

Patients with tachycardia-induced cardiomyopathy most often present with symptoms of congestive heart failure and/or symptoms related to their irregular heart rhythm.[1] Symptoms of congestive heart failure can include shortness of breath, ankle swelling, fatigue, and weight gain.[6] Symptoms of an irregular heart rhythm can include palpitations and chest discomfort.[6]

Diagnosis

This Holter monitor strip of a 5-year-old patient shows atrial tachycardia.[7] This patient was eventually diagnosed with tachycardia-induced cardiomyopathy.[8]

TIC should be suspected in patients presenting with persistent tachycardia or frequent ectopy and left ventricular systolic dysfunction. There are no specific diagnostic criteria for TIC, and it can be difficult to diagnose for a number of reasons. First, it can occur in patients with or without underlying structural heart disease.[9] Additionally, in patients presenting with both tachycardia and cardiomyopathy, it can be difficult to distinguish which is the causative agent.[5] Previously normal left ventricular ejection fraction or left ventricular systolic dysfunction out of proportion to a patient’s underlying cardiac disease can be important clues to possible TIC.[1] The diagnosis of TIC is made after excluding other causes of cardiomyopathy and observing resolution of the left ventricular systolic dysfunction with treatment of the tachyarrhythmia.[1][5][9]

Specific tests that can be used in the diagnosis and monitoring of TIC include electrocardiography (EKG), continuous cardiac rhythm monitoring (e.g. Holter), echocardiography, cardiac magnetic resonance imaging (MRI), and N-terminal pro-B-type natriuretic peptide (NT-pro BNP).

In terms of monitoring cardiac rhythm, patients presenting with possible TIC should have an EKG done to define the rhythm. In order to characterize its frequency, continuous rhythm monitors such as a Holter monitor (hyperlink) can be used. Additionally, some patients may not present to the clinical setting in an abnormal rhythm, and continuous rhythm monitor can be useful to determine if one is present over a longer duration of time.[1]

To assess cardiac structure and function, echocardiography is the most commonly available and utilized modality. In addition to decreased left ventricular ejection fraction, studies indicate that patients with TIC may have a smaller left ventricular end-diastolic diameter compared to patients with idiopathic dilated cardiomyopathy.[1][5] Cardiac MRI has also been used to evaluate patients with possible TIC. Late-gadolinium enhancement on cardiac MRI indicates the presence of fibrosis and scarring, and may be evidence of cardiomyopathy not due to tachycardia.[1][5] A decline in serial NT-pro BNP with control of tachyarrhythmia indicates reversibility of the cardiomyopathy, which would also suggest TIC.[5]

TIC is likely underdiagnosed due to attribution of the tachyarrhythmia to the cardiomyopathy.[1] Poor control of the tachyarrhythmia can result in worsening of heart failure symptoms and irreversible damage to the myocardium.[5] Therefore, it is important to aggressively treat the tachyarrhythmia and monitor patients for resolution of left ventricular systolic dysfunction in cases of suspected TIC.

Treatment

The primary treatment for a tachycardia induced cardiomyopathy is correcting the underlying tachycardia (e.g. ablating an ectopic focus[10]). Supportive agents such as beta blockers and ACE inhibitors / angiotensin receptor blockers are of benefit to try to prevent remodeling of the left ventricle.

If the tachycardia can be abolished, the heart muscle can recover after some time.[11]

Not only is there a need to control the tachycardia that is responsible for causing tachycardia induced cardiomyopathy, but also treating underlying conditions that cause tachycardia. For instance, treatment of hyperthyroidism can also lead to reversal of tachycardia induced cardiomyopathy.

See also

References

  1. 1 2 3 4 5 6 7 8 Ellis, Ethan R.; Josephson, Mark E. (2013-12-01). "Heart failure and tachycardia-induced cardiomyopathy". Current Heart Failure Reports. 10 (4): 296–306. doi:10.1007/s11897-013-0150-z. ISSN 1546-9549. PMID 23963583.
  2. ↑ Phillips, E; Levine, SA (1949). "Auricular fibrillation without other evidence of heart disease: a cause of reversible heart failure". Am J Med. 7: 478–489. doi:10.1016/0002-9343(49)90397-6. PMID 18140546.
  3. ↑ Juneja R, Shah S, et al. (2002). "Management of cardiomyopathy resulting from incessant supraventricular tachycardia in infants and children". India Heart J. 54 (3-4): 176–180. PMID 12086381.
  4. ↑ Ellis, ER; Josephson, ME (December 2013). "Heart failure and tachycardia-induced cardiomyopathy.". Current heart failure reports. 10 (4): 296–306. doi:10.1007/s11897-013-0150-z. PMID 23963583.
  5. 1 2 3 4 5 6 7 8 Gopinathannair, Rakesh; Etheridge, Susan P.; Marchlinski, Francis E.; Spinale, Francis G.; Lakkireddy, Dhanunjaya; Olshansky, Brian (2015-10-13). "Arrhythmia-Induced Cardiomyopathies: Mechanisms, Recognition, and Management". Journal of the American College of Cardiology. 66 (15): 1714–1728. doi:10.1016/j.jacc.2015.08.038. ISSN 0735-1097. PMC 4733572Freely accessible. PMID 26449143.
  6. 1 2 Sabatine, Marc S. (2013-10-07). Pocket Medicine: The Massachusetts General Hospital Handbook of Internal Medicine. Lippincott Williams & Wilkins. ISBN 9781451193787.
  7. ↑ Ahmadi, Alireza; Zolfi-Gol, Ali; Arasteh, Mahfar (2016-11-30). "Tachycardia-induced cardiomyopathy". ARYA Atherosclerosis. 10 (3): 175–178. ISSN 1735-3955. PMC 4144378Freely accessible. PMID 25161690.
  8. ↑ Ahmadi, Alireza; Zolfi-Gol, Ali; Arasteh, Mahfar (2016-11-30). "Tachycardia-induced cardiomyopathy". ARYA Atherosclerosis. 10 (3): 175–178. ISSN 1735-3955. PMC 4144378Freely accessible. PMID 25161690.
  9. 1 2 Lishmanov, Anton; Chockalingam, Priya; Senthilkumar, Annamalai; Chockalingam, Anand (2010-05-01). "Tachycardia-Induced Cardiomyopathy: Evaluation and Therapeutic Options". Congestive Heart Failure. 16 (3): 122–126. doi:10.1111/j.1751-7133.2010.00147.x. ISSN 1751-7133.
  10. ↑ Walker, N L (2004). "Tachycardiomyopathy: a diagnosis not to be missed". Heart. 90: e7. doi:10.1136/hrt.2003.017129. PMID 14729812.
  11. ↑ Calo L, Sciarra L, Scioli R, Lamberti F, Loricchio ML, Pandozi C, Santini M (2005). "Recovery of cardiac function after ablation of atrial tachycardia arising from the tricuspid annulus.". Ital Heart J. 6 (8): 652–7. PMID 16161499.


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