Format

Send to

Choose Destination
See comment in PubMed Commons below
Heart Rhythm. 2014 Jul;11(7):1163-9. doi: 10.1016/j.hrthm.2014.04.023. Epub 2014 Apr 19.

Predictors of myocardial recovery in pediatric tachycardia-induced cardiomyopathy.

Author information

  • 1Division of Pediatric Cardiology, UCLA Medical Center, Los Angeles, California. Electronic address: jpmoore@mednet.ucla.edu.
  • 2Division of Pediatric Cardiology, UCLA Medical Center, Los Angeles, California.
  • 3Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington.
  • 4Division of Cardiology, The Hospital for Sick Children/University of Toronto, Toronto, Canada.
  • 5Department of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
  • 6The Royal Children's Hospital, MCRI and University of Melbourne, Melbourne, Australia.
  • 7The Heart Center, Cincinnati Children's Hospital, Cincinnati, Ohio.
  • 8Division of Pediatric Cardiology, Primary Children's Medical Center, University of Utah, Salt Lake City, Utah.
  • 9University of Colorado Denver/Children's Hospital Colorado, Denver, Colorado.
  • 10Arizona Pediatric Cardiology/Phoenix Children's Hospital, Phoenix, Arizona.
  • 11Division of Pediatric Cardiology, University of British Columbia, British Columbia, Canada.
  • 12Department of Pediatric Cardiology, Medical University of South Carolina, Charelston, South Carolina.
  • 13Department of Pediatrics, Division of Cardiology, Vanderbilt University School of Medicine and the Monroe Carell Jr. Children's Hospital, Nashville, Tennessee.
  • 14Rady Children's Hospital San Diego, UCSD, La Jolla, California.
  • 15Division of Pediatric Cardiology, Loma Linda University Children's Hospital, Loma Linda, California.
  • 16Department of Pediatric Cardiology, Washington University School of Medicine/St. Louis Children's Hospital, St. Louis, Missouri.
  • 17Department of Pediatric Cardiology, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
  • 18Department of Pediatrics, Oregon Health and Science University, Portland, Oregon.

Abstract

BACKGROUND:

Tachycardia-induced cardiomyopathy (TIC) carries significant risk of morbidity and mortality, although full recovery is possible. Little is known about the myocardial recovery pattern.

OBJECTIVE:

The purpose of this study was to determine the time course and predictors of myocardial recovery in pediatric TIC.

METHODS:

An international multicenter study of pediatric TIC was conducted. Children ≤18 years with incessant tachyarrhythmia, cardiac dysfunction (left ventricular ejection fraction [LVEF] <50%), and left ventricular (LV) dilation (left ventricular end-diastolic dimension [LVEDD] z-score ≥2) were included. Children with congenital heart disease or suspected primary cardiomyopathy were excluded. Primary end-points were time to LV systolic functional recovery (LVEF ≥55%) and normal LV size (LVEDD z-score <2).

RESULTS:

Eighty-one children from 17 centers met inclusion criteria: median age 4.0 years (range 0.0-17.5 years) and baseline LVEF 28% (interquartile range 19-39). The most common arrhythmias were ectopic atrial tachycardia (59%), permanent junctional reciprocating tachycardia (23%), and ventricular tachycardia (7%). Thirteen required extracorporeal membrane oxygenation (n = 11) or ventricular assist device (n = 2) support. Median time to recovery was 51 days for LVEF and 71 days for LVEDD. Two (4%) underwent heart transplantation, and 1 died (1%). Multivariate predictors of LV systolic functional recovery were age (hazard ratio [HR] 0.61, P = .040), standardized tachycardia rate (HR 1.16, P = .015), mechanical circulatory support (HR 2.61, P = .044), and LVEF (HR 1.33 per 10% increase, p=0.005). For normalization of LV size, only baseline LVEDD (HR 0.86, P = .008) was predictive.

CONCLUSION:

Pediatric TIC resolves in a predictable fashion. Factors associated with faster recovery include younger age, higher presenting heart rate, use of mechanical circulatory support, and higher LVEF, whereas only smaller baseline LV size predicts reverse remodeling. This knowledge may be useful for clinical evaluation and follow-up of affected children.

Published by Elsevier Inc.

KEYWORDS:

Antiarrhythmic drugs; Cardiomyopathy; Catheter ablation; Supraventricular tachycardia; Ventricular remodeling

[PubMed - indexed for MEDLINE]
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Elsevier Science
    Loading ...
    Write to the Help Desk