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J Am Coll Cardiol. 2019 May 14;73(18):2328-2344. doi: 10.1016/j.jacc.2019.02.045.

Arrhythmia-Induced Cardiomyopathy: JACC State-of-the-Art Review.

Author information

1
Virginia Commonwealth University/Pauley Heart Center, Richmond, Virginia; Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia. Electronic address: jfhuizar@gmail.com.
2
Virginia Commonwealth University/Pauley Heart Center, Richmond, Virginia.
3
Virginia Commonwealth University/Pauley Heart Center, Richmond, Virginia; Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia.

Abstract

Arrhythmias coexist in patients with heart failure (HF) and left ventricular (LV) dysfunction. Tachycardias, atrial fibrillation, and premature ventricular contractions are known to trigger a reversible dilated cardiomyopathy referred as arrhythmia-induced cardiomyopathy (AiCM). It remains unclear why some patients are more prone to develop AiCM despite similar arrhythmia burdens. The challenge is to determine whether arrhythmias are fully, partially, or at all responsible for an observed LV dysfunction. AiCM should be suspected in patients with mean heart rate >100 beats/min, atrial fibrillation, and/or premature ventricular contractions burden ≥10%. Reversal of cardiomyopathy by elimination of the arrhythmia confirms AiCM. Therapeutic choice depends on the culprit arrhythmia, patient comorbidities, and preferences. Following recovery of LV function, patients require continued follow-up if an abnormal myocardial substrate is present. Appropriate diagnosis and treatment of AiCM is likely to improve quality of life and clinical outcomes and to reduce hospital admission and health care spending.

KEYWORDS:

arrhythmia; cardiomyopathy; heart failure; left ventricular dysfunction; premature ventricular contractions; supraventricular tachycardia

PMID:
31072578
DOI:
10.1016/j.jacc.2019.02.045

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