1
|
Schach C, Körtl T, Zeman F, Luttenberger B, Mühleck F, Baum P, Lavall D, Vosshage NH, Resch M, Ripfel S, Meindl C, Ücer E, Hamer OW, Baessler A, Arzt M, Koller M, Sohns C, Maier LS, Wachter R, Sossalla S. Clinical Characterization of Arrhythmia-Induced Cardiomyopathy in Patients With Tachyarrhythmia and Idiopathic Heart Failure. JACC Clin Electrophysiol 2024; 10:870-881. [PMID: 38483417 DOI: 10.1016/j.jacep.2024.102332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 01/18/2024] [Accepted: 01/20/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Arrhythmia-induced cardiomyopathy (AIC) is a known entity, but prospective evidence for its characterization is limited. OBJECTIVES This study aimed to: 1) determine the relative frequency of the pure form of AIC in the clinically relevant cohort of patients with newly diagnosed, otherwise unexplained left ventricular systolic dysfunction (LVSD) and tachyarrhythmia; 2) assess the time to recovery from LVSD; and 3) identify parameters for an early diagnosis of AIC. METHODS Patients were prospectively included, underwent effective rhythm restoration, and were followed-up at 2, 4, and 6 months to evaluate clinical characteristics, biomarkers, and cardiac imaging including cardiac magnetic resonance imaging. Patients with recurred arrhythmia were excluded from analysis. RESULTS 41 of 50 patients were diagnosed with AIC 6 months after rhythm restoration. Left ventricular (LV) ejection fraction increased 2 months after rhythm restoration from 35.4% ± 8.2% to 52.7% ± 8.0% in AIC patients vs 37.0% ± 9.5% to 43.3% ± 7.0% in non-AIC patients. From month 2 to 6, LV ejection fraction continued to increase in AIC patients (57.2% ± 6.1%; P < 0.001) but remained stable in non-AIC patients (44.0% ± 7.8%; P = 0.628). Multivariable logistic regression analysis revealed that lower LV end-diastolic diameter at baseline could be used for early diagnosis of AIC, whereas biomarkers and other morphological or functional parameters, including late LV gadolinium enhancement, did not show suitability for early diagnosis. CONCLUSIONS We observed a high prevalence of AIC in patients with otherwise unexplained LVSD and concomitant tachyarrhythmia, suggesting that this condition may be underdiagnosed in clinical practice. Most patients recovered fast, within months, from LVSD. A low initial LV end-diastolic diameter may constitute an early marker for diagnosis of AIC.
Collapse
Affiliation(s)
- Christian Schach
- Universitäres Herzzentrum Regensburg, Klinik und Poliklinik für Innere Medizin II, Abteilung für Kardiologie, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Thomas Körtl
- Universitäres Herzzentrum Regensburg, Klinik und Poliklinik für Innere Medizin II, Abteilung für Kardiologie, Universitätsklinikum Regensburg, Regensburg, Germany; Justus-Liebig-Universität Giessen, Medizinische Klinik I, Gießen, Germany
| | - Florian Zeman
- Universitätsklinikum Regensburg, Zentrum für Klinische Studien, Regensburg, Germany
| | - Bianca Luttenberger
- Universitäres Herzzentrum Regensburg, Klinik und Poliklinik für Innere Medizin II, Abteilung für Kardiologie, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Franziska Mühleck
- Universitätsklinikum Leipzig, Klinik und Poliklinik für Kardiologie, Leipzig, Germany
| | - Paul Baum
- Universitätsklinikum Leipzig, Klinik und Poliklinik für Kardiologie, Leipzig, Germany
| | - Daniel Lavall
- Universitätsklinikum Leipzig, Klinik und Poliklinik für Kardiologie, Leipzig, Germany
| | - Nicola H Vosshage
- Universitätsklinikum Leipzig, Klinik und Poliklinik für Kardiologie, Leipzig, Germany
| | - Markus Resch
- Caritas Krankenhaus St. Josef, Abteilung für Kardiologie, Regensburg, Germany
| | - Sarah Ripfel
- Universitäres Herzzentrum Regensburg, Klinik und Poliklinik für Innere Medizin II, Abteilung für Kardiologie, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Christine Meindl
- Universitäres Herzzentrum Regensburg, Klinik und Poliklinik für Innere Medizin II, Abteilung für Kardiologie, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Ekrem Ücer
- Universitäres Herzzentrum Regensburg, Klinik und Poliklinik für Innere Medizin II, Abteilung für Kardiologie, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Okka W Hamer
- Universitäres Herzzentrum Regensburg, Institut für Röntgendiagnostik, Regensburg, Germany
| | - Andrea Baessler
- Universitäres Herzzentrum Regensburg, Klinik und Poliklinik für Innere Medizin II, Abteilung für Kardiologie, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Michael Arzt
- Universitäres Herzzentrum Regensburg, Klinik und Poliklinik für Innere Medizin II, Abteilung für Kardiologie, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Michael Koller
- Universitätsklinikum Regensburg, Zentrum für Klinische Studien, Regensburg, Germany
| | - Christian Sohns
- Ruhr-Universität Bochum, Klinik für Elektrophysiologie, Bad Oeynhausen, Germany
| | - Lars S Maier
- Universitäres Herzzentrum Regensburg, Klinik und Poliklinik für Innere Medizin II, Abteilung für Kardiologie, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Rolf Wachter
- Universitätsklinikum Leipzig, Klinik und Poliklinik für Kardiologie, Leipzig, Germany
| | - Samuel Sossalla
- Universitäres Herzzentrum Regensburg, Klinik und Poliklinik für Innere Medizin II, Abteilung für Kardiologie, Universitätsklinikum Regensburg, Regensburg, Germany; Justus-Liebig-Universität Giessen, Medizinische Klinik I, Gießen, Germany; Campus der Universität Giessen, Kerckhoff-Klinik, Abteilung für Kardiologie, Bad Nauheim, Germany.
| |
Collapse
|
2
|
Keefe JA, Garber R, McCauley MD, Wehrens XHT. Tachycardia and Atrial Fibrillation-Related Cardiomyopathies: Potential Mechanisms and Current Therapies. JACC. HEART FAILURE 2024; 12:605-615. [PMID: 38206235 DOI: 10.1016/j.jchf.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/06/2023] [Accepted: 11/28/2023] [Indexed: 01/12/2024]
Abstract
Atrial fibrillation (AF) is associated with an increased risk of new-onset ventricular contractile dysfunction, termed arrhythmia-induced cardiomyopathy (AIC). Although cardioembolic stroke remains the most feared and widely studied complication of AF, AIC is also a clinically important consequence of AF that portends significant morbidity and mortality to patients with AF. Current treatments are aimed at restoring sinus rhythm through catheter ablation and rate and rhythm control, but these treatments do not target the underlying molecular mechanisms driving the progression from AF to AIC. Here, we describe the clinical features of the various AIC subtypes, discuss the pathophysiologic mechanisms driving the progression from AF to AIC, and review the evidence surrounding current treatment options. In this review, we aim to identify key knowledge gaps that will enable the development of more effective AIC therapies that target cellular and molecular mechanisms.
Collapse
Affiliation(s)
- Joshua A Keefe
- Cardiovascular Research Institute, Baylor College of Medicine, Houston, Texas, USA; Department of Integrative Physiology, Baylor College of Medicine, Houston, Texas, USA
| | - Rebecca Garber
- Division of Cardiology, Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Mark D McCauley
- Division of Cardiology, Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA; Department of Physiology and Biophysics and the Center for Cardiovascular Research, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA; Jesse Brown VA Medical Center, Chicago, Illinois, USA.
| | - Xander H T Wehrens
- Cardiovascular Research Institute, Baylor College of Medicine, Houston, Texas, USA; Department of Integrative Physiology, Baylor College of Medicine, Houston, Texas, USA; Departments of Pediatrics, Medicine, and Neuroscience, and Center for Space Medicine, Baylor College of Medicine, Houston, Texas, USA.
| |
Collapse
|
3
|
Zhao X, Hu X, Bao W, Huang S, Li F, Liu C, Ge L, Zhang Q, Zhang C, Li C. Predictors of improvement in left ventricular systolic function after catheter ablation in patients with persistent atrial fibrillation complicated with heart failure. BMC Cardiovasc Disord 2024; 24:178. [PMID: 38521897 PMCID: PMC10960375 DOI: 10.1186/s12872-024-03840-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 03/12/2024] [Indexed: 03/25/2024] Open
Abstract
AIMS The current management of patients with atrial fibrillation (AF) and concomitant heart failure (HF) remains a significant challenge. Catheter ablation (CA) has been shown to improve left ventricular ejection fraction (LVEF) in these patients, but which patients can benefit from CA is still poorly understood. The aim of our study was to determine the predictors of improved ejection fraction in patients with persistent atrial fibrillation (PeAF) complicated with HF undergoing CA. METHODS AND RESULTS A total of 435 patients with persistent AF underwent an initial CA between January 2019 and March 2023 in our hospital. We investigated consecutive patients with left ventricular systolic dysfunction (LVEF < 50%) measured by transthoracic echocardiography (TTE) within one month before CA. According to the LVEF changes at 6 months, these patients were divided into an improved group (fulfilling the '2021 Universal Definition of HF' criteria for LVEF recovery) and a nonimproved group. Eighty patients were analyzed, and the improvement group consisted of 60 patients (75.0%). In the univariate analysis, left ventricular end-diastolic diameter (P = 0.005) and low voltage zones in the left atrium (P = 0.043) were associated with improvement of LVEF. A receiver operating characteristic analysis determined that the suitable cutoff value for left ventricular end-diastolic diameter (LVDd) was 59 mm (sensitivity: 85.0%, specificity: 55.0%, area under curve: 0.709). A multivariate analysis showed that LVDd (OR = 0.85; 95% CI: 0.76-0.95, P = 0.005) and low voltage zones (LVZs) (OR = 0.26; 95% CI: 0.07-0.96, P = 0.043) were significantly independently associated with the improvement of LVEF. Additionally, parameters were significantly improved regarding the left atrial diameter, LVDd and ventricular rate after radiofrequency catheter ablation (all p < 0.05). CONCLUSIONS The improvement of left ventricular ejection fraction (LVEF) occurred in 75.0% of patients. Our study provides additional evidence that LVDd < 59 mm and no low voltage zones in the left atrium can be used to jointly predict the improvement of LVEF after atrial fibrillation ablation.
Collapse
Affiliation(s)
- Xinliang Zhao
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China
| | - Xiaoqin Hu
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China
| | - Wei Bao
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China
| | - Shuo Huang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China
| | - Fei Li
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China
| | - Chen Liu
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China
| | - Liqi Ge
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China
| | - Quan Zhang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China
| | - Chaoqun Zhang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China
| | - Chengzong Li
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China.
| |
Collapse
|
4
|
De Larochellière H, Brouillette F, Lévesque P, Dognin N, St-Germain R, Rimac G, Lemay S, Philippon F, Sénéchal M. Severity of Left Ventricular Dysfunction in Patients With Tachycardia-Induced Cardiomyopathy: Impacts on Remodeling After Atrial Flutter Ablation. Am J Cardiol 2024; 213:132-139. [PMID: 38114044 DOI: 10.1016/j.amjcard.2023.11.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/12/2023] [Accepted: 11/24/2023] [Indexed: 12/21/2023]
Abstract
Tachycardia-induced cardiomyopathy is defined as a reversible left ventricular (LV) systolic dysfunction (SeD) resulting from a sustained fast heart rate. LV remodeling in patients with severe LV dysfunction at diagnosis remains poorly understood. In this retrospective cohort study, we described LV remodeling in 50 patients who underwent atrial flutter ablation. These patients were divided into severe LV SeD (LV ejection fraction [EF] ≤30%) and LV nonsevere SeD (LVEF 31% to 50%) at baseline. All continuous variables are expressed as median and interquartile range. LVEF was 18% (13 to 25) and 38% (34 to 41) in the SeD (n = 29) and LV nonsevere SeD (n = 21) groups, respectively. At baseline, patients with SeD had higher LV end-diastolic diameter (56 [54 to 59] vs 49 mm [47 to 52], p <0.01), LV end-systolic diameter (48 [43 to 51] vs 36 mm [34 to 41], p <0.01), LV end-diastolic volume (71 [64 to 85] vs 56 ml/m2 [46 to 68], p <0.01), LV end-systolic volume (56 [53 to 70] vs 36 ml/m2 [27 to 42], p <0.01), and lower tricuspid annular plane systolic excursion (12 [10 to 13] vs 16 mm [13 to 19], p <0.01). At last follow-up, LVEF was not statistically significantly different between groups. However, LV end-systolic diameter (36 [34 to 39] vs 32 mm [32 to 34], p = 0.01) and LV end-systolic volume (29 [26 to 35] vs 25 ml/m2 [20 to 29], p = 0.02) remained larger in the SeD group. Seven patients (14%), all from the SeD group, had a LVEF ≤35% 2 months after rhythm control, and reverse remodeling was observed up to 9 months. In conclusion, more than half of patients with tachycardia-induced cardiomyopathy and atrial flutter had LVEF ≤30% at baseline. LVEF recovery and LV remodeling were observed beyond 2 months, highlighting the importance of rhythm control and early guideline-directed medical therapy in these patients.
Collapse
Affiliation(s)
- Hugo De Larochellière
- Division of Cardiology, Institut Universitaire de Cardiologie et Pneumologie de Québec (IUCPQ), Université Laval, Québec City, Québec, Canada
| | - François Brouillette
- Division of Cardiology, Institut Universitaire de Cardiologie et Pneumologie de Québec (IUCPQ), Université Laval, Québec City, Québec, Canada
| | - Patrick Lévesque
- Division of Cardiology, Institut Universitaire de Cardiologie et Pneumologie de Québec (IUCPQ), Université Laval, Québec City, Québec, Canada
| | - Nicolas Dognin
- Division of Cardiology, Institut Universitaire de Cardiologie et Pneumologie de Québec (IUCPQ), Université Laval, Québec City, Québec, Canada
| | - Raphaël St-Germain
- Division of Cardiology, Institut Universitaire de Cardiologie et Pneumologie de Québec (IUCPQ), Université Laval, Québec City, Québec, Canada
| | - Goran Rimac
- Division of Cardiology, Institut Universitaire de Cardiologie et Pneumologie de Québec (IUCPQ), Université Laval, Québec City, Québec, Canada
| | - Sylvain Lemay
- Division of Cardiology, Institut Universitaire de Cardiologie et Pneumologie de Québec (IUCPQ), Université Laval, Québec City, Québec, Canada
| | - François Philippon
- Division of Cardiology, Institut Universitaire de Cardiologie et Pneumologie de Québec (IUCPQ), Université Laval, Québec City, Québec, Canada
| | - Mario Sénéchal
- Division of Cardiology, Institut Universitaire de Cardiologie et Pneumologie de Québec (IUCPQ), Université Laval, Québec City, Québec, Canada.
| |
Collapse
|
5
|
Bruno J, Räber L, Schnegg B, Primiceri L. Thrombus entrapment with left atrial appendage closure to facilitate early cardioversion in tachycardiomyopathy: a case report. Eur Heart J Case Rep 2024; 8:ytad618. [PMID: 38173782 PMCID: PMC10762891 DOI: 10.1093/ehjcr/ytad618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 11/22/2023] [Accepted: 12/07/2023] [Indexed: 01/05/2024]
Abstract
Background The aetiological spectrum of heart failure with reduced ejection fraction is various. Tachycardiomyopathy is recognized as one of the cause, usually made retrospectively. In this clinical context, rhythm control with restoration of sinus rhythm is considered crucial to minimize ventricular function damage and allow contractility recovery. However, the presence of a thrombus in the left atrial appendage is a limiting factor, typically requiring anticoagulation until the thrombus resolves, at least 3 weeks, thus delaying the therapy. Case summary We present a case of 65-year-old man with diagnosis of new-onset acute symptomatic heart failure with severe reduced ejection fraction (left ventricular ejection fraction 15%), in the context of a typical tachycardic atrial flutter and concomitant thrombus in the left atrial appendage confirmed by transoesophageal echocardiography. We successfully performed a thrombus entrapment procedure by means of percutaneous left atrial appendage closure, which allowed immediate restoration of sinus rhythm through cavotricuspid isthmus ablation. After the institution of the heart failure therapy, titrated up to the maximum tolerated dose, we observed a complete restoration of left ventricular function after 6 months. Discussion Thrombus entrapment by means of left atrial appendage closure is a valid strategy that enables early cardioversion with arrhythmia ablation and rapid restoration of normal cardiac rhythm in severe heart failure with reduced ejection fraction, even in acute situations and typical atrial flutter.
Collapse
Affiliation(s)
- Jolie Bruno
- Department of Cardiology, Bern University Hospital, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Bruno Schnegg
- Department of Cardiology, Bern University Hospital, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Livia Primiceri
- Department of Cardiology, Bern University Hospital, Freiburgstrasse 18, 3010 Bern, Switzerland
| |
Collapse
|
6
|
Körtl T, Schach C, Sossalla S. How arrhythmias weaken the ventricle: an often underestimated vicious cycle. Herz 2023; 48:115-122. [PMID: 36695877 DOI: 10.1007/s00059-022-05158-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 01/26/2023]
Abstract
Arrhythmia-induced cardiomyopathy (AIC) is classified as a form of dilated cardiomyopathy in which left ventricular systolic dysfunction (LVSD) is triggered by tachycardic or arrhythmic heart rates. On the one hand AIC can develop in patients without cardiac disease and on the other hand it can appear in patients with pre-existing LVSD, leading to a further reduction in left ventricular (LV) ejection fraction. A special aspect of AIC is the potential termination or partial reversibility of LVSD; thus, AIC is curatively treatable by the elimination of the underlying arrhythmia. Since arrhythmias are often seen merely as a consequence than as an underlying cause of LVSD, and due to the fact that the diagnosis of AIC can be made only after recovery of LV function, the prevalence of AIC is probably underestimated in clinical practice. Pathophysiologically, animal models have shown that continuous tachycardic pacing induces consecutive changes such as the occurrence of LVSD, increased filling pressures, LV dilatation, and decreased cardiac output. After termination of tachycardia, reversibility of the described pathologies can usually be observed. Studies in human ventricular myocardium have recently demonstrated that various cellular structural and functional mechanisms are activated even by normofrequent atrial fibrillation, which may help to explain the clinical AIC phenotype.
Collapse
Affiliation(s)
- Thomas Körtl
- Klinik und Poliklinik für Innere Medizin II, Universitäres Herzzentrum Regensburg, Franz-Josef-Strauss-Allee 11, 93042, Regensburg, Germany
| | - Christian Schach
- Klinik und Poliklinik für Innere Medizin II, Universitäres Herzzentrum Regensburg, Franz-Josef-Strauss-Allee 11, 93042, Regensburg, Germany
| | - Samuel Sossalla
- Klinik und Poliklinik für Innere Medizin II, Universitäres Herzzentrum Regensburg, Franz-Josef-Strauss-Allee 11, 93042, Regensburg, Germany.
- Klinik und Poliklinik für Kardiologie & Pneumologie, Georg-August Universität Göttingen und Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Göttingen, Germany.
| |
Collapse
|
7
|
Ermert L, Kreimer F, Quast DR, Pflaumbaum A, Mügge A, Gotzmann M. Rate of atrial fibrillation and flutter induced tachycardiomyopathy in a cohort of hospitalized patients with heart failure and detection of indicators for improved diagnosis. Front Cardiovasc Med 2023; 9:940060. [PMID: 36712260 PMCID: PMC9878112 DOI: 10.3389/fcvm.2022.940060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 12/30/2022] [Indexed: 01/13/2023] Open
Abstract
Background Atrial fibrillation (AF) and atrial flutter (AFL) induced tachycardiomyopathy (TCM) has been known to cause reversible heart failure (HF) for many years. However, the prevalence of the disease is unknown, and diagnosis is challenging. Therefore, the aim of the present study was (1) to assess the rate of AF/AFL induced TCM and (2) to identify indicators for diagnosis. Methods Consecutively, all patients with a diagnosis of HF who were hospitalized in our department within 12 months were reviewed. For the main analysis, all patients with HF with reduced ejection fraction (HFrEF) and AF or AFL were included. AF/AFL induced TCM was diagnosed when there was at least a 10% improvement in left ventricular ejection fraction under rhythm or rate control within 3 months. Patients with HFrEF with AF/AFL but without TCM served as control group. Results A total of 480 patients were included. AF/AFL induced TCM occurred in 26 patients (5.4%) and HFrEF with AF/AFL in 53 patients (11%). Independent indicators of AF/AFL induced TCM were age<79 years [Odds ratio 5.887, confidence interval (CI) 1.999-17.339, p < 0.001], NT-pro-BNP <5,419 pg/mL (Odds ratio 2.327, CI 1.141-4.746, p = 0.004), and a resting heart rate >112 bpm (Odds ratio 2.503, CI 1.288-4.864, p = 0.001). Conclusion Approximately 5% of all patients hospitalized for HF suffer from AF/AFL induced TCM. Improved discrimination of AF/AFL induced TCM to HFrEF with AF/AFL is possible considering age, NT-pro-BNP level, and resting heart rate >112 beats/minute. Based on these parameters, an earlier diagnosis and improved therapy might be possible.
Collapse
Affiliation(s)
- Lynn Ermert
- University Hospital St. Josef-Hospital Bochum, Cardiology and Rhythmology, Ruhr-University Bochum, Bochum, Germany
| | - Fabienne Kreimer
- University Hospital St. Josef-Hospital Bochum, Cardiology and Rhythmology, Ruhr-University Bochum, Bochum, Germany
| | - Daniel R. Quast
- University Hospital St. Josef-Hospital Bochum, Internal Medicine, Ruhr-University Bochum, Bochum, Germany
| | - Andreas Pflaumbaum
- University Hospital St. Josef-Hospital Bochum, Cardiology and Rhythmology, Ruhr-University Bochum, Bochum, Germany
| | - Andreas Mügge
- University Hospital St. Josef-Hospital Bochum, Cardiology and Rhythmology, Ruhr-University Bochum, Bochum, Germany
| | - Michael Gotzmann
- University Hospital St. Josef-Hospital Bochum, Cardiology and Rhythmology, Ruhr-University Bochum, Bochum, Germany,*Correspondence: Michael Gotzmann,
| |
Collapse
|
8
|
Boxhammer E, Bellamine M, Szendey I, Foresti M, Bonsels M, Kletzer J, Jirak P, Topf A, Kraus J, Fiedler L, Dieplinger AM, Hoppe UC, Strohmer B, Eckardt L, Pistulli R, Motloch LJ, Larbig R. Impact of cavotricuspid isthmus ablation for typical atrial flutter and heart failure in the elderly-results of a retrospective multi-center study. Front Cardiovasc Med 2023; 10:1109404. [PMID: 37139138 PMCID: PMC10150054 DOI: 10.3389/fcvm.2023.1109404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 03/21/2023] [Indexed: 05/05/2023] Open
Abstract
Introduction While in the CASTLE-AF trial, in patients with atrial fibrillation and heart failure with reduced ejection fraction, interventional therapy using pulmonary vein isolation was associated with outcome improvement, data on cavotricuspid isthmus ablation (CTIA) in atrial flutter (AFL) in the elderly is rare. Methods We included 96 patients between 60 and 85 years with typical AFL and heart failure with reduced or mildly reduced ejection fraction (HFrEF/HFmrEF) treated in two medical centers. 48 patients underwent an electrophysiological study with CTIA, whereas 48 patients received rate or rhythm control and guideline-compliant heart failure therapy. Patients were followed up for 2 years, with emphasis on left ventricular ejection fraction (LVEF) over time. Primary endpoints were cardiovascular mortality and hospitalization for cardiac causes. Results Patients with CTIA showed a significant increase in LVEF after 1 (p < 0.001) and 2 years (p < 0.001) in contrast to baseline LVEF. Improvement of LVEF in the CTIA group was associated with significantly lower 2-year mortality (p = 0.003). In the multivariate regression analysis, CTIA remained the relevant factor associated with LVEF improvement (HR: 2.845 CI:95% 1.044-7.755; p = 0.041). Elderly patients (≥ 70 years) further benefited from CTIA, since they showed a significantly reduced rehospitalization (p = 0.042) and mortality rate after 2 years (p = 0.013). Conclusions CTIA in patients with typical AFL and HFrEF/HFmrEF was associated with significant improvement of LVEF and reduced mortality rates after 2 years. Patient age should not be a primary exclusion criterion for CTIA, since patients ≥70 years also seem to benefit from intervention in terms of mortality and hospitalization.
Collapse
Affiliation(s)
- Elke Boxhammer
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Meriem Bellamine
- Division of Cardiology, Hospital Maria Hilf Mönchengladbach, Mönchengladbach, Germany
| | - Istvan Szendey
- Division of Cardiology, Hospital Maria Hilf Mönchengladbach, Mönchengladbach, Germany
| | - Mike Foresti
- Division of Cardiology, Hospital Maria Hilf Mönchengladbach, Mönchengladbach, Germany
| | - Marc Bonsels
- Division of Cardiology, Hospital Maria Hilf Mönchengladbach, Mönchengladbach, Germany
| | - Joseph Kletzer
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Peter Jirak
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Albert Topf
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
- Clinic for Internal Medicine, Hospital Villach, Villach, Austria
| | - Johannes Kraus
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Lukas Fiedler
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
- Department of Internal Medicine II, Wiener Neustadt Hospital, Wiener Neustadt, Austria
| | - Anna-Maria Dieplinger
- Medical Faculty, Johannes Kepler University Linz, Linz, Austria
- Nursing Science Program, Institute for Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
| | - Uta C. Hoppe
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Bernhard Strohmer
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Lars Eckardt
- Department of Cardiology II-Electrophysiology, University Hospital Muenster, Muenster, Germany
| | - Rudin Pistulli
- Department of Cardiology I, Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Muenster, Germany
| | - Lukas J. Motloch
- Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Robert Larbig
- Division of Cardiology, Hospital Maria Hilf Mönchengladbach, Mönchengladbach, Germany
- Department of Cardiology II-Electrophysiology, University Hospital Muenster, Muenster, Germany
- Correspondence: Robert Larbig
| |
Collapse
|
9
|
Silverdal J, Bollano E, Henrysson J, Basic C, Fu M, Sjöland H. Treatment response in recent-onset heart failure with reduced ejection fraction: non-ischaemic vs. ischaemic aetiology. ESC Heart Fail 2022; 10:542-551. [PMID: 36331067 PMCID: PMC9871650 DOI: 10.1002/ehf2.14214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 09/13/2022] [Accepted: 10/07/2022] [Indexed: 11/06/2022] Open
Abstract
AIMS In heart failure (HF) with reduced left ventricular ejection fraction (HFrEF), the prognosis appears better in non-ischaemic than in ischaemic aetiology. Infrequent diagnostic work-up for ischaemic heart disease (IHD) in HF is reported. In this study, we compared short-term response to initiated guideline-directed medical treatment (GDMT) in recent-onset HFrEF of non-ischaemic (non-IHF) vs. ischaemic (IHF) aetiology and evaluated the frequency of coronary investigation. METHODS AND RESULTS Patients hospitalized with recent-onset HFrEF [left ventricular ejection fraction (LVEF) < 40%] between 1 January 2016 and 31 December 2019 were included. Treatment response was determined by use of a hierarchical clinical composite outcome classifying each patient as worsened, improved, or unchanged based on hard outcomes (mortality, heart transplantation, and HF hospitalization) and soft outcomes (± ≥10 unit change in LVEF, ± ≥30% change in N-terminal pro-B-type natriuretic peptide, and ± ≥1 point change in New York Heart Association functional class) during 28 weeks of follow-up. The associations between baseline characteristics and composite changes were analysed with multiple logistic regression. Among the 364 patients analysed, 47 were not investigated for IHD. Comparing non-IHF (n = 203) vs. IHF (n = 114), patients were younger (mean age 61.0 vs. 69.4 years, P < 0.001) with lower mean LVEF (26% vs. 31%, P < 0.001), but with similar male predominance (70.4% vs. 75.4%, P = 0.363). For non-IHF vs. IHF, the composite outcomes were worsened (19.1% vs. 43.9%, P < 0.001) and improved (74.2% vs. 43.9%, P < 0.001). After multivariable adjustments, IHF was associated with increased odds for worsening [odds ratio (OR) 2.94; 95% confidence interval (CI) 1.51-5.74; P = 0.002] and decreased odds for improvement (OR 0.35; 95% CI 0.18-0.65; P < 0.001). In cases without previous IHD or new-onset myocardial infarction (n = 261), a decision for coronary investigation was made in 69.0%. CONCLUSIONS In recent-onset HFrEF, patients with non-IHF responded better to GDMT than patients with IHF. Almost one-third of patients selected for follow-up at HF clinics were never investigated for IHD.
Collapse
Affiliation(s)
- Jonas Silverdal
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden,Department of Internal Medicine, Geriatrics and Emergency CareSahlgrenska University HospitalGothenburgSweden
| | - Entela Bollano
- Department of CardiologySahlgrenska University HospitalGothenburgSweden
| | - Josefin Henrysson
- Department of Internal Medicine, Geriatrics and Emergency CareSahlgrenska University HospitalGothenburgSweden
| | - Carmen Basic
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden,Department of Internal Medicine, Geriatrics and Emergency CareSahlgrenska University HospitalGothenburgSweden
| | - Michael Fu
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden,Department of Internal Medicine, Geriatrics and Emergency CareSahlgrenska University HospitalGothenburgSweden
| | - Helen Sjöland
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden,Department of Internal Medicine, Geriatrics and Emergency CareSahlgrenska University HospitalGothenburgSweden
| |
Collapse
|
10
|
Purwowiyoto SL, Kusharsamita H. Arrhythmia-induced Cardiomyopathy: An Article Review. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Arrhythmia is one of the significant reversible causes in patients with heart disease and left ventricular dysfunction. Tachycardia, atrial fibrillation, and premature ventricular contractions have indeed been related to arrhythmia-induced cardiomyopathy (CM), a reversible dilated CM. Effective arrhythmia suppression will entirely or partially recover ventricular function, lowering morbidity and mortality. However, the importance of arrhythmia-induced CM (ARiCM) is often underestimated in clinical practice because arrhythmia is often seen as a result rather than a cause of CM, leading in treatment delays and failure to increase the quality of life and better clinical outcomes. This article review aims to summarize the pathomechanisms, and a general approach to the management of ARiCM and its long-term outcomes. ARiCM can cause a variety of clinical signs, ranging from asymptomatic to severe heart failure symptoms. Electrocardiogram, 24 h Holter monitoring, echocardiography, and cardiac magnetic resonance are all recommended for diagnosis. More research is required to better understand the pathogenesis of ARiCM and to differentiate treatment alternatives to choose the ideal ARiCM management approach.
Collapse
|
11
|
Lee WC, Fang HY, Chen HC, Chen YL, Pan KL, Lin YS, Chen MC. Is it possible to expect left ventricular ejection fraction improvement in patients with known advanced heart diseases in the case of right atrial flutter treated by ablation? Int J Clin Pract 2021; 75:e14582. [PMID: 34185378 DOI: 10.1111/ijcp.14582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/24/2021] [Accepted: 06/26/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Atrial flutter (AFL)-related tachycardia-induced cardiomyopathy (TICM) is a treatable cause of heart failure (HF). This study aims to explore the effect of AFL ablation on left ventricular (LV) function in right AFL patients with or without advanced heart diseases. METHODS Between January 2013 and December 2019, 149 patients underwent ablation for persistent AFL. Among them, 60 patients with persistent right atrial (RA) flutter had symptomatic HF and elevated natriuretic peptide levels. Group 1 consisted of 35 patients without advanced heart diseases, and group 2 consisted of 25 patients with prior history of ischemic cardiomyopathy (ICM), dilated cardiomyopathy (DCM) or surgery for valvular heart disease (VHD). Follow-up echocardiography was performed 6 months later. Improvement of LV performance was defined as LV ejection fraction (EF) increase ≥50% of baseline EF without clinical HF symptoms or LVEF recovery to ≥60%. RESULTS Group 2 had larger LV end-diastolic volume (LVEDV) and LV end-systolic volume than group 1. At follow-up, group 2 had larger LV end-systolic volume than group 1. Group 1 had more increase in LVEF than group 2 (21.7 ± 15.2% vs 4.1 ± 13.2%; P < .001). A receiver operating characteristic curve was constructed to determine the discrimination threshold of baseline LVEDV (137 mL) in the overall study group for improvement of LV performance after ablation (P = .005). CONCLUSIONS Successful ablation for right AFL could achieve more reversal of LV dysfunction in patients without advanced heart diseases. Pre-ablation LVEDV ≥ 137 mL was associated with no improvement of LV performance after ablation.
Collapse
Affiliation(s)
- Wei-Chieh Lee
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsiu-Yu Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Huang-Chung Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yung-Lung Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kuo-Li Pan
- Division of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yu-Sheng Lin
- Division of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Mien-Cheng Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| |
Collapse
|
12
|
Diamant MJ, Andrade JG, Virani SA, Jhund PS, Petrie MC, Hawkins NM. Heart failure and atrial flutter: a systematic review of current knowledge and practices. ESC Heart Fail 2021; 8:4484-4496. [PMID: 34505352 PMCID: PMC8712920 DOI: 10.1002/ehf2.13526] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/04/2021] [Accepted: 07/05/2021] [Indexed: 01/14/2023] Open
Abstract
While the interplay between heart failure (HF) and atrial fibrillation (AF) has been extensively studied, little is known regarding HF and atrial flutter (AFL), which may be managed differently. We reviewed the incidence, prevalence, and predictors of HF in AFL and vice versa, and the outcomes of treatment of AFL in HF. A systematic literature review of PubMed/Medline and EMBASE yielded 65 studies for inclusion and qualitative synthesis. No study described the incidence or prevalence of AFL in unselected patients with HF. Most cohorts enrolled patients with AF/AFL as interchangeable diagnoses, or highly selected patients with tachycardia‐induced cardiomyopathy. The prevalence of HF in AFL ranged from 6% to 56%. However, the phenotype of HF was never defined by left ventricular ejection fraction (LVEF). No studies reported the predictors, phenotype, and prognostic implications of AFL in HF. There was significant variation in treatments studied, including the proportion that underwent ablation. When systolic dysfunction was tachycardia‐mediated, catheter ablation demonstrated LVEF normalization in up to 88%, as well as reduced cardiovascular mortality. In summary, AFL and HF often coexist but are understudied, with no randomized trial data to inform care. Further research is warranted to define the epidemiology and establish optimal management.
Collapse
Affiliation(s)
- Michael J Diamant
- Division of Cardiology, Royal Columbian Hospital, New Westminster, British Columbia, Canada.,Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jason G Andrade
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sean A Virani
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Pardeep S Jhund
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Mark C Petrie
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Nathaniel M Hawkins
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
13
|
Tersalvi G, Gasperetti A, Schiavone M, Dauw J, Gobbi C, Denora M, Krul JD, Cioffi GM, Mitacchione G, Forleo GB. Acute heart failure in elderly patients: a review of invasive and non-invasive management. J Geriatr Cardiol 2021; 18:560-576. [PMID: 34404992 PMCID: PMC8352772 DOI: 10.11909/j.issn.1671-5411.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Acute heart failure (AHF) is a major cause of unplanned hospitalisations in the elderly and is associated with high mortality. Its prevalence has grown in the last years due to population aging and longer life expectancy of chronic heart failure patients. Although international societies have provided guidelines for the management of AHF in the general population, scientific evidence for geriatric patients is often lacking, as these are underrepresented in clinical trials. Elderly have a different risk profile with more comorbidities, disability, and frailty, leading to increased morbidity, longer recovery time, higher readmission rates, and higher mortality. Furthermore, therapeutic options are often limited, due to unfeasibility of invasive strategies, mechanical circulatory support and cardiac transplantation. Thus, the in-hospital management of AHF should be tailored to each patient's clinical situation, cardiopulmonary condition and geriatric assessment. Palliative care should be considered in some cases, in order to avoid unnecessary diagnostics and/or treatments. After discharge, a strict follow-up through outpatient clinic or telemedicine is can improve quality of life and reduce rehospitalisation rates. The aim of this review is to offer an insight on current literature and provide a clinically oriented, patient-tailored approach regarding assessment, treatment and follow-up of elderly patients admitted for AHF.
Collapse
Affiliation(s)
- Gregorio Tersalvi
- Department of Internal Medicine, Hirslanden Klinik St. Anna, Lucerne, Switzerland
| | - Alessio Gasperetti
- Cardiology Unit, ASST-Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Marco Schiavone
- Cardiology Unit, ASST-Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Jeroen Dauw
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
- Doctoral School for Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Cecilia Gobbi
- Institut Cardiovasculaire de Caen, Hôpital Privé Saint Martin, Caen, France
| | - Marialessia Denora
- Cardiology Unit, ASST-Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Joel Daniel Krul
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Giacomo Maria Cioffi
- Division of Cardiology, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Gianfranco Mitacchione
- Cardiology Unit, ASST-Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Giovanni B. Forleo
- Cardiology Unit, ASST-Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy
| |
Collapse
|
14
|
Taylor ME, McDiarmid AK, Matthews IG, Kakarla J, McComb JM, Parry G, Lord SW. A retrospective evaluation of catheter ablation in atrial flutter post cardiac transplantation. Clin Transplant 2021; 35:e14429. [PMID: 34265128 DOI: 10.1111/ctr.14429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 06/30/2021] [Accepted: 07/12/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Atrial flutter is the most common arrhythmia post cardiac transplantation. Observational studies in the non-transplant population have shown prognostic benefit with catheter ablation; however, there are no data in the heart transplant population. OBJECTIVES This study evaluated the experience of catheter ablation in atrial flutter post cardiac transplantation. METHODS A retrospective review of experience of late onset atrial flutter at the Freeman Hospital, Newcastle-upon-Tyne, UK, between 1985 and January 2020. RESULTS Sixty eight of the 722 patients who survived 6 months post cardiac transplantation developed late atrial flutter giving an incidence of 9.4%. Thirty-two patients were managed with ablation with treatment largely determined by time of flutter onset. Kaplan Meier estimates for arrhythmia free survival post first ablation for organized atrial arrhythmias was 83.3% at 1 year. Kaplan-Meier estimates for median survival post onset of atrial arrhythmias treated with ablation was 11.34 years (95% CI 8.00-14.57), compared to 5.79 years in patients managed medically (95%CI 2.26-9.32) (P = .026). CONCLUSIONS Atrial flutter is an important late complication of cardiac transplantation. Patients treated with ablation in the modern era had increased survival compared to a historical cohort.
Collapse
Affiliation(s)
- Mark E Taylor
- Department of Cardiology, Freeman Hospital, Newcastle-upon-Tyne, UK
| | - Adam K McDiarmid
- Department of Cardiology, Freeman Hospital, Newcastle-upon-Tyne, UK
| | - Iain G Matthews
- Department of Cardiology, Northumbria Healthcare, Wansbeck Hospital, Woodhorn Lane, Ashington, UK
| | - Jayant Kakarla
- Department of Cardiology, Freeman Hospital, Newcastle-upon-Tyne, UK
| | - Janet M McComb
- Department of Cardiology, Freeman Hospital, Newcastle-upon-Tyne, UK
| | - Gareth Parry
- Institute of Transplantation, Freeman Hospital, Newcastle-upon-Tyne, UK
| | - Stephen W Lord
- Department of Cardiology, Freeman Hospital, Newcastle-upon-Tyne, UK
| |
Collapse
|
15
|
The effect of patient characteristics to the acute procedural success and long term outcome of atrial tachycardia and atrial flutter cases undergoing catheter ablation. MARMARA MEDICAL JOURNAL 2021. [DOI: 10.5472/marumj.943128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
16
|
Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, Boriani G, Castella M, Dan GA, Dilaveris PE, Fauchier L, Filippatos G, Kalman JM, Meir ML, Lane DA, Lebeau JP, Lettino M, Lip GY, Pinto FJ, Neil Thomas G, Valgimigli M, Van Gelder IC, Van Putte BP, Watkins CL. Guía ESC 2020 sobre el diagnóstico y tratamiento de la fibrilación auricular, desarrollada en colaboración de la European Association of Cardio-Thoracic Surgery (EACTS). Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
17
|
Atabegashvili MR, Shchekochikhin DY, Gromyko GA, Pershina ES, Bogdanova AA, Nesterov AP, Shilova AS, Gilyarov MY, Svet AV. Tachicardia-induced cardiomyopathy. Case report. TERAPEVT ARKH 2021; 93:465-469. [DOI: 10.26442/00403660.2021.04.200803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 06/02/2021] [Indexed: 11/22/2022]
Abstract
The tachycardia-induced cardiomyopathy is a rare case of reversible heart failure and left ventricle disfunction. The diagnostic approach and treatment strategy are described in this article. Also the clinical case of heart failure compensation in the patient with left ventricle dilatation and atrial flutter after the reverse to sinus rhythm is after catheter ablation presented.
Collapse
|
18
|
Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, Boriani G, Castella M, Dan GA, Dilaveris PE, Fauchier L, Filippatos G, Kalman JM, La Meir M, Lane DA, Lebeau JP, Lettino M, Lip GYH, Pinto FJ, Thomas GN, Valgimigli M, Van Gelder IC, Van Putte BP, Watkins CL. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J 2021; 42:373-498. [PMID: 32860505 DOI: 10.1093/eurheartj/ehaa612] [Citation(s) in RCA: 5414] [Impact Index Per Article: 1804.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
|
19
|
Sinagra G, Elliott PM, Merlo M. Dilated cardiomyopathy: so many cardiomyopathies! Eur Heart J 2019; 41:3784-3786. [DOI: 10.1093/eurheartj/ehz908] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 10/20/2019] [Accepted: 12/09/2019] [Indexed: 11/15/2022] Open
Affiliation(s)
- Gianfranco Sinagra
- Cardiovascular Department, Center for Diagnosis and Treatment of Cardiomyopathies, Azienda Sanitaria Universitaria Integrata (ASUITS), University of Trieste, Via P. Valdoni 7, 34100 Trieste, Italy
| | - Perry M Elliott
- Centre for Heart Muscle Disease, Institute of Cardiological Sciences, University College London and St. Bartholomew's Hospital, Gower St, Bloomsbury, London WC1E 6BT, UK
| | - Marco Merlo
- Cardiovascular Department, Center for Diagnosis and Treatment of Cardiomyopathies, Azienda Sanitaria Universitaria Integrata (ASUITS), University of Trieste, Via P. Valdoni 7, 34100 Trieste, Italy
| |
Collapse
|
20
|
Sossalla S, Vollmann D. Arrhythmia-Induced Cardiomyopathy. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 115:335-341. [PMID: 29875055 DOI: 10.3238/arztebl.2018.0335] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 10/01/2017] [Accepted: 02/22/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Heart failure affects 1–2% of the population and is associated with elevated morbidity and mortality. Cardiac arrhythmias are often a result of heart failure, but they can cause left-ventricular systolic dysfunction (LVSD) as an arrhythmia-induced cardiomyopathy (AIC). This causal relationship should be borne in mind by the physician treating a patient with systolic heart failure in association with cardiac arrhythmia. METHODS This review is based on pertinent publications retrieved by a selective search in PubMed (1987–2017) and on the recommendations in current guidelines. RESULTS The key criterion for the diagnosis of an AIC is the demonstration of a persistent arrhythmia (including pathological tachycardia) together with an LVSD whose origin cannot be explained on any other basis. Nearly any type of tachyarrhythmia or frequent ventricular extrasystoles can lead, if persistent, to a progressively severe LVSD. The underlying pathophysiologic mechanisms are incompletely understood; the increased ventricular rate, asynchronous cardiac contractions, and neurohumoral activation all seem to play a role. The most common precipitating factors are supraventricular tachycardias in children and atrial fibrillation in adults. Recent studies have shown that the causal significance of atrial fibrillation in otherwise unexplained LVSD is underappreciated. The treatment of AIC consists primarily of the treatment of the underlying arrhythmia, generally with drugs such as beta-blockers and amiodarone. Depending on the type of arrhythmia, catheter ablation for long-term treatment should also be considered where appropriate. The diagnosis of AIC is considered to be well established when the LVSD normalizes or improves within a few weeks or months of the start of targeted treatment of the arrhythmia. CONCLUSION An AIC is potentially reversible. The timely recognition of this condition and the appropriate treatment of the underlying arrhythmia can substantially improve patient outcomes.
Collapse
Affiliation(s)
- Samuel Sossalla
- Department of Internal Medicine II, Cardiology, Pneumology, Intensive Care, University Hospital Regensburg
| | | |
Collapse
|
21
|
Turkish Society of Cardiology consensus paper on management of arrhythmia-induced cardiomyopathy. Anatol J Cardiol 2019; 21:98-106. [PMID: 30833535 PMCID: PMC6457428 DOI: 10.14744/anatoljcardiol.2019.60687] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
|
22
|
König S, Ueberham L, Schuler E, Wiedemann M, Reithmann C, Seyfarth M, Sause A, Tebbenjohanns J, Schade A, Shin DI, Staudt A, Zacharzowsky U, Andrié R, Wetzel U, Neuser H, Wunderlich C, Kuhlen R, Tijssen JGP, Hindricks G, Bollmann A. In-hospital mortality of patients with atrial arrhythmias: insights from the German-wide Helios hospital network of 161 502 patients and 34 025 arrhythmia-related procedures. Eur Heart J 2018; 39:3947-3957. [PMID: 30165430 DOI: 10.1093/eurheartj/ehy528] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Accepted: 08/11/2018] [Indexed: 01/17/2024] Open
Abstract
Aims Atrial fibrillation (AFib) and atrial flutter (AFlut) are common arrhythmias with increased use of invasive procedures. A steady re-evaluation of relevant safety endpoints is recommended and both quality management and pay-for-performance programs are evolving. Therefore, the aims of this study were (i) to investigate and report overall in-hospital mortality and mortality of invasive arrhythmia-related procedures and (ii) to identify mortality predictors in a German-wide hospital network. Methods and results Administrative data provided by 78 Helios hospitals between 2010 and 2017 were examined using International Statistical Classification of Diseases and Related Health Problems- and Operations and Procedures-codes to identify patients with AFib or AFlut as main discharge diagnosis or secondary diagnosis combined with invasive arrhythmia-related interventions. In 161 502 patients, in-hospital mortality was 0.6% with a significant decrease from 0.75% to 0.5% (P < 0.01) during the observational period. In multivariable analysis, age [odds ratio (OR) 2.69, 95% confidence interval (CI) 2.36-3.05; P < 0.01], high centre volume (OR 0.57, 95% CI 0.50-0.65; P < 0.01), emergency hospital admission (OR 1.57, 95% CI 1.38-1.79; P < 0.01), and Charlson Comorbidity Index (CCI, OR 4.95, 95% CI 4.50-5.44; P < 0.01) were found as independent predictors of in-hospital mortality. Mortality rates were 0.05% for left atrial catheter ablation (CA, n = 21 744), 0.3% for right atrial CA (n = 9972), and 0.56% for implantation of a left atrial appendage occluder (n = 2309), respectively. Conclusion We analysed for the first time in-hospital mortality rates of patients with atrial arrhythmias in a German-wide, multi-centre administrative dataset. This allows feasible, comparable, and up-to-date performance measurement of clinically important endpoints in a real-world setting which may contribute to quality management programs and towards value-based healthcare.
Collapse
Affiliation(s)
- Sebastian König
- Department of Electrophysiology, Heart Center Leipzig - Universital Hospital, Strümpellstraße 39, 04289 Leipzig, Germany
- Leipzig Heart Institute, Russenstraße 69a, 04289 Leipzig, Germany
| | - Laura Ueberham
- Department of Electrophysiology, Heart Center Leipzig - Universital Hospital, Strümpellstraße 39, 04289 Leipzig, Germany
- Leipzig Heart Institute, Russenstraße 69a, 04289 Leipzig, Germany
| | - Ekkehard Schuler
- Helios Kliniken GmbH, Friedrichstraße 136, 10117 Berlin, Germany
| | - Michael Wiedemann
- Department of Cardiology, Helios Hospital Berlin-Buch, Schwanebecker Chaussee 50, 13125 Berlin, Germany
| | - Christopher Reithmann
- Department of Internal Medicine I, Helios Hospital München West, Steinerweg 5, 81241 München, Germany
| | - Melchior Seyfarth
- Department of Cardiology, Helios University Hospital Wuppertal, Heusnerstraße 40, 42283 Wuppertal, Germany
| | - Armin Sause
- Department of Cardiology, Helios University Hospital Wuppertal, Heusnerstraße 40, 42283 Wuppertal, Germany
| | - Jürgen Tebbenjohanns
- Department of Cardiology, Helios Hospital Hildesheim, Senator-Braun-Allee 33, 31135 Hildesheim, Germany
| | - Anja Schade
- Department of Cardiology, Helios Hospital Erfurt, Nordhäuser Straße 74, 99089 Erfurt, Germany
| | - Dong-In Shin
- Department of Cardiology, Helios Hospital Krefeld, Lutherplatz 40, 47805 Krefeld, Germany
| | - Alexander Staudt
- Department of Cardiology and Angiology, Helios Hospital Schwerin, Wismarische Straße 393-397, 19053 Schwerin, Germany
| | - Udo Zacharzowsky
- Department of Cardiology, Helios Hospital Bad Saarow, Pieskower Straße 33, 15526 Bad Saarow, Germany
| | - René Andrié
- Department of Cardiology, Helios Hospital Siegburg, Ringstraße 49, 53721 Siegburg, Germany
| | - Ulrike Wetzel
- Department of Cardiology, Helios Hospital Aue, Gartenstraße 6, 08280 Aue, Germany
| | - Hans Neuser
- Department of Internal Medicine II, Helios Hospital Plauen, Röntgenstraße 2, 08529 Plauen, Germany
| | - Carsten Wunderlich
- Department of Internal Medicine II, Helios Hospital Pirna, Struppener Straße 13, 01796 Pirna, Germany
| | - Ralf Kuhlen
- Leipzig Heart Institute, Russenstraße 69a, 04289 Leipzig, Germany
- Helios Kliniken GmbH, Friedrichstraße 136, 10117 Berlin, Germany
| | - Jan G P Tijssen
- Academic Medical Center - University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig - Universital Hospital, Strümpellstraße 39, 04289 Leipzig, Germany
- Leipzig Heart Institute, Russenstraße 69a, 04289 Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center Leipzig - Universital Hospital, Strümpellstraße 39, 04289 Leipzig, Germany
- Leipzig Heart Institute, Russenstraße 69a, 04289 Leipzig, Germany
| |
Collapse
|
23
|
Eiringhaus J, Hamer OW, Hollemann D, Brochhausen C, Vollmann D, Maier LS, Sossalla S. The detrimental potential of arrhythmia-induced cardiomyopathy. ESC Heart Fail 2018; 5:960-964. [PMID: 30079993 PMCID: PMC6165941 DOI: 10.1002/ehf2.12343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/31/2018] [Accepted: 06/22/2018] [Indexed: 11/14/2022] Open
Abstract
Here we discuss a case of arrhythmia‐induced cardiomyopathy (AIC) with consecutive severe multiple organ failure. In relation to this imposing case, we discuss the significance of this potentially underestimated cause of newly occurred left‐ventricular systolic dysfunction and concomitant arrhythmia. We further delineate the diagnostic algorithm and differential diagnoses of AIC.
Collapse
Affiliation(s)
- Jörg Eiringhaus
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Okka W Hamer
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, Regensburg, Germany
| | - David Hollemann
- Institut für Pathologie, Universität Regensburg, Regensburg, Germany
| | | | | | - Lars S Maier
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Samuel Sossalla
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| |
Collapse
|
24
|
|
25
|
Usefulness of the WCD in patients with suspected tachymyopathy. Clin Res Cardiol 2017; 107:70-75. [PMID: 28993851 DOI: 10.1007/s00392-017-1159-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 08/31/2017] [Indexed: 10/18/2022]
Abstract
AIMS The wearable cardioverter defibrillator (WCD) is used for temporary protection of patients deemed to be at high risk for sudden death. There is limited experience regarding the clinical development of patients with tachymyopathy. We aimed to evaluate the clinical development of tachymyopathy patients protected with a WCD in a single-center non-randomized patient cohort. METHODS AND RESULTS We fitted 130 consecutive patients deemed to be at high risk for ventricular tachyarrhythmias with the WCD. Of these, 20 patients (15%) presenting with newly diagnosed heart failure in the setting of rapidly conducted atrial fibrillation/flutter were suspected to suffer from tachymyopathy. The control group consisted of the remaining 110 patients with other indications for WCD therapy. LVEF increased by more than 10% in 13/20 (65%) tachymyopathy patients compared to 40/110 (36%) patients in the control population (p = 0.01). Similarly, BNP levels decreased in 15/20 (75%) tachymyopathy patients compared to 41/110 (37%) in the control group (p = 0.05). ICD implantation rates were lower in the tachymyopathy group (3/20) compared to the control population (40/110; p = 0.04). On further follow-up (mean 12 ± 8 months), patients with suspected tachymyopathy had no sustained ventricular arrhythmias. Compared to 5/110 patients in the control group, no tachymyopathy patient died. CONCLUSION Most of the patients with suspected tachymyopathy have a favorable clinical outcome. The WCD is useful for temporary protection while LV function recovers.
Collapse
|
26
|
Penela D, Fernández-Armenta J, Aguinaga L, Tercedor L, Ordoñez A, Bisbal F, Acosta J, Rossi L, Borras R, Doltra A, Ortiz-Pérez JT, Bosch X, Perea RJ, Prat-González S, Soto-Iglesias D, Tolosana JM, Vassanelli F, Cabrera M, Linhart M, Martinez M, Mont L, Berruezo A. Clinical recognition of pure premature ventricular complex-induced cardiomyopathy at presentation. Heart Rhythm 2017; 14:1864-1870. [PMID: 28756100 DOI: 10.1016/j.hrthm.2017.07.025] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Frequent premature ventricular complexes (PVCs) can induce or worsen left ventricular (LV) systolic dysfunction. OBJECTIVE The purpose of this study was to identify the clinical pattern of patients having a "pure PVC-induced" cardiomyopathy at presentation. METHODS This prospective multicenter study included 155 consecutive patients (age 55 ± 12 years, 96 men [62%], 23% ±12% mean PVC burden) with LV dysfunction and frequent PVCs submitted for ablation and followed up for at least 12 months. Patients with a previously diagnosed structural heart disease (50 [32%]) and those without complete PVC abolition during follow-up who did not normalize LV ejection fraction (LVEF) (24 [15%]) were excluded from the analysis. RESULTS Of the remaining 81 patients, 41 (51%) had a successful sustained ablation, did not have normalized LVEF, and were classified as having PVC-worsened nonischemic cardiomyopathy, and 40 (49%) who had normalized LVEF were considered as having pure PVC-induced cardiomyopathy. The latter group had higher baseline PVC burden (27% ± 12% vs 12% ± 8%; P <.001), smaller LV end-diastolic diameter (58 ± 5 mm vs 60 ± 6 mm; P = .05), and shorter intrinsic QRS (105 ± 12 vs 129 ± 24 ms; P <.001). Any of the following baseline characteristics accurately identified patients who will not normalize LVEF after PVC ablation (85% sensitivity, 98% specificity): intrinsic QRS >130 ms, baseline PVC burden <17%, and LV end-diastolic diameter >63 mm. CONCLUSION Almost half of patients with frequent PVCs and low LVEF of unknown origin normalize LVEF after sustained PVC abolition, and these patients can be identified before ablation.
Collapse
Affiliation(s)
| | | | | | | | - Augusto Ordoñez
- Hospital Sant Pau i Santa Tecla, Tarragona, Catalonia, Spain
| | - Felipe Bisbal
- Heart Institute (iCor)-Hospital Universitari Germans Trias i Pujol, Badalona and CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Juan Acosta
- Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Luca Rossi
- Ospedale Guglielmo da Saliceto, Piacenza, Italy
| | - Roger Borras
- Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Catalonia, Spain
| | - Adelina Doltra
- Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Catalonia, Spain
| | - José T Ortiz-Pérez
- Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Catalonia, Spain
| | - Xavier Bosch
- Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Catalonia, Spain
| | - Rosario J Perea
- Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Catalonia, Spain
| | - Susana Prat-González
- Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Catalonia, Spain
| | - David Soto-Iglesias
- Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Catalonia, Spain
| | - Jose M Tolosana
- Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Catalonia, Spain
| | - Francesca Vassanelli
- Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Catalonia, Spain
| | - Mario Cabrera
- Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Catalonia, Spain
| | - Markus Linhart
- Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Catalonia, Spain
| | - Mikel Martinez
- Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Catalonia, Spain
| | - Lluis Mont
- Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Catalonia, Spain
| | - Antonio Berruezo
- Hospital Clínic and IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Catalonia, Spain.
| |
Collapse
|
27
|
[Permanent junctional reciprocating tachycardia causing cardiomyopathy in an adult woman]. Herzschrittmacherther Elektrophysiol 2016; 27:404-407. [PMID: 27605234 DOI: 10.1007/s00399-016-0453-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 08/06/2016] [Indexed: 10/21/2022]
Abstract
A 35-year-old female was referred with progressive dyspnoea and elevated heart rate. Surface electrocardiography (ECG) showed supraventricular tachycardia (SVT) with long RP interval and inverse P waves. ECG revealed left ventricular dilation and severe systolic dysfunction. An electrophysiological (EP) examination was performed due to incessant SVT despite betablocker medication. Permanent junctional reciprocating tachycardia (PJRT) was diagnosed and successfully ablated. During follow-up, the patient's symptoms abated and ECG parameters normalized. PJRT is usually found in infants and children, but should also be considered as a rare cause of incessant SVT and tachycardiomyopathy in adults.
Collapse
|
28
|
Metra M. April 2016 at a glance. Focus on cardiac remodeling, biomarkers and treatment. Eur J Heart Fail 2016; 18:345-6. [PMID: 27203474 DOI: 10.1002/ejhf.542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| |
Collapse
|