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Shoureshi P, Tan AY, Koneru J, Ellenbogen KA, Kaszala K, Huizar JF. Arrhythmia-Induced Cardiomyopathy: JACC State-of-the-Art Review. J Am Coll Cardiol 2024; 83:2214-2232. [PMID: 38811098 DOI: 10.1016/j.jacc.2024.03.416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 03/12/2024] [Accepted: 03/14/2024] [Indexed: 05/31/2024]
Abstract
Arrhythmias frequently accompany heart failure and left ventricular dysfunction. Tachycardias, atrial fibrillation, and premature ventricular contractions can induce a reversible form of dilated cardiomyopathy (CM) known as arrhythmia-induced CM (AiCM). The intriguing question is why certain individuals are more susceptible to AiCM, despite similar arrhythmia burdens. The primary challenge is determining the extent of arrhythmias' contribution to left ventricular systolic dysfunction. AiCM should be considered in patients with a mean heart rate of >100 beats/min, atrial fibrillation, or a PVC burden of >10%. Confirmation of AiCM occurs when CM reverses upon eliminating the responsible arrhythmia. Therapy choice depends on the specific arrhythmia, patient comorbidities, and preferences. After left ventricular function is restored, ongoing follow-up is essential if an abnormal myocardial substrate persists. Accurate diagnosis and treatment of AiCM have the potential to enhance patients' quality of life, improve clinical outcomes, and reduce hospital admissions and overall health care costs.
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Affiliation(s)
- Pouria Shoureshi
- Virginia Commonwealth University/Pauley Heart Center, Richmond, Virginia, USA; Central Virginia Veterans Affair Health Care System, Richmond, Virginia, USA
| | - Alex Y Tan
- Virginia Commonwealth University/Pauley Heart Center, Richmond, Virginia, USA; Central Virginia Veterans Affair Health Care System, Richmond, Virginia, USA
| | - Jayanthi Koneru
- Virginia Commonwealth University/Pauley Heart Center, Richmond, Virginia, USA
| | | | - Karoly Kaszala
- Virginia Commonwealth University/Pauley Heart Center, Richmond, Virginia, USA; Central Virginia Veterans Affair Health Care System, Richmond, Virginia, USA
| | - Jose F Huizar
- Virginia Commonwealth University/Pauley Heart Center, Richmond, Virginia, USA; Central Virginia Veterans Affair Health Care System, Richmond, Virginia, USA.
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Sakai T, Tsuboi K, Takarada S, Okabe M, Nakaoka H, Ibuki K, Ozawa SW, Hata Y, Ichimata S, Nishida N, Hirono K. Tachycardia-Induced Cardiomyopathy in an Infant with Atrial Flutter and Prolonged Recovery of Cardiac Function. J Clin Med 2024; 13:3313. [PMID: 38893024 PMCID: PMC11172730 DOI: 10.3390/jcm13113313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 05/21/2024] [Accepted: 05/31/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Tachycardia-induced cardiomyopathy (TIC) is caused by prolonged tachycardia, leading to left ventricular dilatation and systolic dysfunction with heart failure. Although TIC is more common in adults, it is rare in early infancy. Methods: Clinical testing was performed as part of medical evaluation and management. Next-generation sequencing (NGS) was conducted for a patient with TIC. A literature review on TIC was also conducted. Results: The case involved a 5-month-old infant referred to the hospital due to symptoms of heart failure lasting at least two months. The infant's heart rate was 200 beats per minute, the left ventricular ejection fraction fell below 14%, and electrocardiograms showed atrial flutter, suggesting TIC. After cardioversion, there was no recurrence of atrial flutter, and cardiac function improved 98 days after tachycardia arrest. The NGS did not identify any pathogenic variants. The literature review identified eight early infantile cases of TIC. However, no previous reports described a case with such a prolonged duration of TIC as ours. Conclusions: This is the first report of a case of prolonged TIC in a child with the documented time to recover normal cardiac function. The improvement of cardiac function depends on the duration of TIC. Early recognition and intervention in TIC are essential to improve outcomes for infantile patients, as timely treatment offers the potential for recovery.
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Affiliation(s)
- Tomohide Sakai
- Department of Pediatrics, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan; (T.S.)
| | - Kaori Tsuboi
- Department of Pediatrics, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan; (T.S.)
| | - Shinya Takarada
- Department of Pediatrics, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan; (T.S.)
| | - Mako Okabe
- Department of Pediatrics, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan; (T.S.)
| | - Hideyuki Nakaoka
- Department of Pediatrics, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan; (T.S.)
| | - Keijiro Ibuki
- Department of Pediatrics, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan; (T.S.)
| | - Sayaka W. Ozawa
- Department of Pediatrics, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan; (T.S.)
| | - Yukiko Hata
- Department of Legal Medicine, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Shojiro Ichimata
- Department of Legal Medicine, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Naoki Nishida
- Department of Legal Medicine, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Keiichi Hirono
- Department of Pediatrics, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan; (T.S.)
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Serban T, Badertscher P, du Fay de Lavallaz J, Providencia R, Migliore F, Mugnai G, Penela D, Perrotta L, Kühne M, Sticherling C, Chun KRJ. Definition and management of arrhythmia-induced cardiomyopathy: findings from the European Heart Rhythm Association survey. Europace 2024; 26:euae112. [PMID: 38693772 PMCID: PMC11094751 DOI: 10.1093/europace/euae112] [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: 03/12/2024] [Accepted: 04/25/2024] [Indexed: 05/03/2024] Open
Abstract
AIMS Arrhythmia-induced cardiomyopathy (AiCM) represents a subtype of acute heart failure (HF) in the context of sustained arrhythmia. Clear definitions and management recommendations for AiCM are lacking. The European Heart Rhythm Association Scientific Initiatives Committee (EHRA SIC) conducted a survey to explore the current definitions and management of patients with AiCM among European and non-European electrophysiologists. METHODS AND RESULTS A 25-item online questionnaire was developed and distributed among EP specialists on the EHRA SIC website and on social media between 4 September and 5 October 2023. Of the 206 respondents, 16% were female and 61% were between 30 and 49 years old. Most of the respondents were EP specialists (81%) working at university hospitals (47%). While most participants (67%) agreed that AiCM should be defined as a left ventricular ejection fraction (LVEF) impairment after new onset of an arrhythmia, only 35% identified a specific LVEF drop to diagnose AiCM with a wide range of values (5-20% LVEF drop). Most respondents considered all available therapies: catheter ablation (93%), electrical cardioversion (83%), antiarrhythmic drugs (76%), and adjuvant HF treatment (76%). A total of 83% of respondents indicated that adjuvant HF treatment should be started at first HF diagnosis prior to antiarrhythmic treatment, and 84% agreed it should be stopped within six months after LVEF normalization. Responses for the optimal time point for the first LVEF reassessment during follow-up varied markedly (1 day-6 months after antiarrhythmic treatment). CONCLUSION This EHRA Survey reveals varying practices regarding AiCM among physicians, highlighting a lack of consensus and heterogenous care of these patients.
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Affiliation(s)
- Teodor Serban
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Patrick Badertscher
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Jeanne du Fay de Lavallaz
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Rui Providencia
- Department of Cardiology, St Bartholomew’s Hospital, London, UK
| | - Federico Migliore
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Giacomo Mugnai
- Department of Cardiology, University Hospital of Verona, Verona, Italy
| | - Diego Penela
- Department of Cardiology, Medical Centre Teknon, Grupo Quironsalud, Barcelona, Spain
| | - Laura Perrotta
- Department of Cardiology, Careggi University Hospital, Florence, Italy
| | - Michael Kühne
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Christian Sticherling
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Kyoung-Ryul Julian Chun
- Department of Electrophysiology, Cardiology and Angiology Center Bethanien, Frankfurt, Germany
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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.
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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.
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Orlov O, Asfour A, Shchekochikhin D, Magomedova Z, Bogdanova A, Komarova A, Podianov M, Gromyko G, Pershina E, Nesterov A, Shilova A, Ionina N, Andreev D. Cardiac Magnetic Resonance in Patients with Suspected Tachycardia-Induced Cardiomyopathy: The Impact of Late Gadolinium Enhancement and Epicardial Fat Tissue. J Pers Med 2023; 13:1440. [PMID: 37888051 PMCID: PMC10607955 DOI: 10.3390/jpm13101440] [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: 07/02/2023] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 10/28/2023] Open
Abstract
Tachycardia-induced cardiomyopathy (TIC) is a reversible subtype of dilated cardiomyopathy (DCM) resulting from sustained supraventricular or ventricular tachycardia and diagnosed by the normalization of left ventricular ejection fraction (LVEF) after stable sinus rhythm restoration. The aim of this study was to determine the contribution of cardiac magnetic resonance (CMR) to the differential diagnosis of TIC and DCM with persistent atrial arrythmias in patients hospitalized for the first time with heart failure (HF) with reduced LVEF of nonischemic origin. A total of 29 patients (age: 58.2 ± 16.9 years; males: 65.5%; average EF: 37.0 ± 9.5%) with persistent atrial tachyarrhythmia and first decompensation of HF without known coronary artery diseases were included in this study. The patients successfully underwent cardioversion and were observed for 30 days. The study population was divided into groups of responders (TIC patients; N = 16), which implies achieving FF > 50% or its increase > 10% in 30 days of TIC, and non-responders (N = 13). The increase in left ventricle (LV) volumes measured using CMR was significantly higher in the non-responder group when compared with the responders (114.8 mL ± 25.1 vs. 68.1 mL ± 10.5, respectively, p < 0.05). Non-responders also demonstrated decreased interventricular septum thickness (9.1 ± 0.8 vs.11.5 ± 1.3, respectively, p < 0.05). Late gadolinium enhancement (LGE) was observed in 12 patients (41.4%). The prevalence of LGE was increased in the non-responder group (25.0% vs. 65.1%, respectively, p = 0.046). Notably, a septal mid-wall LGE pattern was found exclusively in the non-responders. Epicardial adipose tissue thickness was decreased in the non-responder group versus the TIC patients. Conclusion: Patients with TIC were found to have smaller atrial and ventricular dimensions in comparison to patients with DCM. In addition, LGE was more common in DCM patients.
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Affiliation(s)
- Oleg Orlov
- Department of Cardiology, Functional and Ultrasound Diagnostics, N.V. Sklifosovsky Institute of Clinical Medicine, I. M. Sechenov First Moscow State Medical University, 8 Trubetskaya Str., 119991 Moscow, Russia; (O.O.); (Z.M.); (E.P.)
| | - Aref Asfour
- Department of Cardiology, Functional and Ultrasound Diagnostics, N.V. Sklifosovsky Institute of Clinical Medicine, I. M. Sechenov First Moscow State Medical University, 8 Trubetskaya Str., 119991 Moscow, Russia; (O.O.); (Z.M.); (E.P.)
| | - Dmitry Shchekochikhin
- Department of Cardiology, Functional and Ultrasound Diagnostics, N.V. Sklifosovsky Institute of Clinical Medicine, I. M. Sechenov First Moscow State Medical University, 8 Trubetskaya Str., 119991 Moscow, Russia; (O.O.); (Z.M.); (E.P.)
- Moscow State Healthcare Institution, City Clinical Hospital №1, 8 Leninsky Ave., 119049 Moscow, Russia; (A.N.); (A.S.)
- Department Intervention Cardiology and Cardiac Rehabilitation, Pirogov Russian National Research Medical University, 1 Ostrovitianinova Str., 117997 Moscow, Russia
| | - Zainab Magomedova
- Department of Cardiology, Functional and Ultrasound Diagnostics, N.V. Sklifosovsky Institute of Clinical Medicine, I. M. Sechenov First Moscow State Medical University, 8 Trubetskaya Str., 119991 Moscow, Russia; (O.O.); (Z.M.); (E.P.)
| | - Alexandra Bogdanova
- Department of Cardiology, Functional and Ultrasound Diagnostics, N.V. Sklifosovsky Institute of Clinical Medicine, I. M. Sechenov First Moscow State Medical University, 8 Trubetskaya Str., 119991 Moscow, Russia; (O.O.); (Z.M.); (E.P.)
- Moscow State Healthcare Institution, City Clinical Hospital №1, 8 Leninsky Ave., 119049 Moscow, Russia; (A.N.); (A.S.)
- Department Intervention Cardiology and Cardiac Rehabilitation, Pirogov Russian National Research Medical University, 1 Ostrovitianinova Str., 117997 Moscow, Russia
| | - Anna Komarova
- Department of Cardiology, Functional and Ultrasound Diagnostics, N.V. Sklifosovsky Institute of Clinical Medicine, I. M. Sechenov First Moscow State Medical University, 8 Trubetskaya Str., 119991 Moscow, Russia; (O.O.); (Z.M.); (E.P.)
| | - Maxim Podianov
- Department of Cardiology, Functional and Ultrasound Diagnostics, N.V. Sklifosovsky Institute of Clinical Medicine, I. M. Sechenov First Moscow State Medical University, 8 Trubetskaya Str., 119991 Moscow, Russia; (O.O.); (Z.M.); (E.P.)
| | - Grigory Gromyko
- Department of Endovascular Diagnostics and Treatment, Russian Biotechnological University (ROSBIOTECH), 33 Talalikhina Str., 109029 Moscow, Russia
| | - Ekaterina Pershina
- Department of Cardiology, Functional and Ultrasound Diagnostics, N.V. Sklifosovsky Institute of Clinical Medicine, I. M. Sechenov First Moscow State Medical University, 8 Trubetskaya Str., 119991 Moscow, Russia; (O.O.); (Z.M.); (E.P.)
- Moscow State Healthcare Institution, City Clinical Hospital №1, 8 Leninsky Ave., 119049 Moscow, Russia; (A.N.); (A.S.)
- World-Class Research Center, “Digital Biodesign and Personalized Healthcare”, I. M. Sechenov First Moscow State Medical University, 8 Trubetskaya Str., 119991 Moscow, Russia
| | - Alexey Nesterov
- Moscow State Healthcare Institution, City Clinical Hospital №1, 8 Leninsky Ave., 119049 Moscow, Russia; (A.N.); (A.S.)
- Department Intervention Cardiology and Cardiac Rehabilitation, Pirogov Russian National Research Medical University, 1 Ostrovitianinova Str., 117997 Moscow, Russia
| | - Alexandra Shilova
- Moscow State Healthcare Institution, City Clinical Hospital №1, 8 Leninsky Ave., 119049 Moscow, Russia; (A.N.); (A.S.)
- Department Intervention Cardiology and Cardiac Rehabilitation, Pirogov Russian National Research Medical University, 1 Ostrovitianinova Str., 117997 Moscow, Russia
| | - Natalya Ionina
- Department of Cardiology, Functional and Ultrasound Diagnostics, N.V. Sklifosovsky Institute of Clinical Medicine, I. M. Sechenov First Moscow State Medical University, 8 Trubetskaya Str., 119991 Moscow, Russia; (O.O.); (Z.M.); (E.P.)
| | - Dennis Andreev
- Department of Cardiology, Functional and Ultrasound Diagnostics, N.V. Sklifosovsky Institute of Clinical Medicine, I. M. Sechenov First Moscow State Medical University, 8 Trubetskaya Str., 119991 Moscow, Russia; (O.O.); (Z.M.); (E.P.)
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Báez Cabanillas MV, Colque R, Tibaldi MÁ, Kaplinsky E, Perrone S, Barbagelata A. Emerging concepts in heart failure management and treatment: focus on tachycardia-induced cardiomyopathy. Drugs Context 2023; 12:dic-2022-8-4. [PMID: 36660016 PMCID: PMC9828873 DOI: 10.7573/dic.2022-8-4] [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: 08/28/2022] [Accepted: 11/07/2022] [Indexed: 01/04/2023] Open
Abstract
Tachycardia-induced cardiomyopathy is an entity characterized by reversible dysfunction of the left ventricle, which can be induced by different types of arrhythmia such as atrial fibrillation, atrial flutter, incessant supraventricular tachycardia and ventricular arrhythmia (more frequent causes). Correct identification of the causative arrhythmia and normalization of the heart rate (e.g through medical treatment, electrical cardioversion, ablation) can lead to recovery of left ventricular function. Tachycardia-induced cardiomyopathy should be suspected in patients with tachycardia and left ventricular dysfunction (heart failure setting), especially when there is no history of previous heart disease. Its usual phenotype is that of non-ischaemic/non-valvular dilated cardiomyopathy and it can occur in both children (main cause: permanent junctional reciprocating tachycardia) and adults (main cause: atrial fibrillation). With proper treatment, most cases recover within a few months, though there is a risk of relapse, especially when the causal arrhythmia reappears or its control is lost. This is a narrative review that comprehensively addresses the pathophysiology, clinical manifestations, and therapeutic management of tachycardia-induced cardiomyopathy. This article is part of the Emerging concepts in heart failure management and treatment Special Issue: https://www.drugsincontext.com/special_issues/emerging-concepts-in-heart-failure-management-and-treatment.
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Affiliation(s)
- María Victoria Báez Cabanillas
- Catholic University of Argentina, Buenos Aires, Argentina,Cardiovascular Medicine Department, Sanatorio Allende, Córdoba, Argentina
| | - Roberto Colque
- Cardiovascular Medicine Department, Sanatorio Allende, Córdoba, Argentina
| | | | - Edgardo Kaplinsky
- Cardiology Unit, Medicine Department, Hospital Municipal de Badalona, Barcelona, Spain
| | - Sergio Perrone
- Catholic University of Argentina, Buenos Aires, Argentina,Fleni Institute, Buenos Aires, Argentina
| | - Alejandro Barbagelata
- Catholic University of Argentina, Buenos Aires, Argentina,Duke University School of Medicine, Durham, NC, USA
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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.
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Prinzen FW, Auricchio A, Mullens W, Linde C, Huizar JF. OUP accepted manuscript. Eur Heart J 2022; 43:1917-1927. [PMID: 35265992 PMCID: PMC9123241 DOI: 10.1093/eurheartj/ehac088] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/02/2021] [Accepted: 02/22/2022] [Indexed: 11/14/2022] Open
Abstract
Electrical disturbances, such as atrial fibrillation (AF), dyssynchrony, tachycardia, and premature ventricular contractions (PVCs), are present in most patients with heart failure (HF). While these disturbances may be the consequence of HF, increasing evidence suggests that they may also cause or aggravate HF. Animal studies show that longer-lasting left bundle branch block, tachycardia, AF, and PVCs lead to functional derangements at the organ, cellular, and molecular level. Conversely, electrical treatment may reverse or mitigate HF. Clinical studies have shown the superiority of atrial and pulmonary vein ablation for rhythm control and AV nodal ablation for rate control in AF patients when compared with medical treatment. Ablation of PVCs can also improve left ventricular function. Cardiac resynchronization therapy (CRT) is an established adjunct therapy currently undergoing several interesting innovations. The current guideline recommendations reflect the safety and efficacy of these ablation therapies and CRT, but currently, these therapies are heavily underutilized. This review focuses on the electrical treatment of HF with reduced ejection fraction (HFrEF). We believe that the team of specialists treating an HF patient should incorporate an electrophysiologist in order to achieve a more widespread use of electrical therapies in the management of HFrEF and should also include individual conditions of the patient, such as body size and gender in therapy fine-tuning.
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Affiliation(s)
| | - Angelo Auricchio
- Division of Cardiology, Istituto Cardiocentro Ticino, Lugano, Switzerland
| | - Wilfried Mullens
- Ziekenhuis Oost Limburg, Genk, Belgium
- Biomedical Research Institute, Faculty of Medicine and Life Sciences, University Hasselt, Hasselt, Belgium
| | - Cecilia Linde
- Department of Medicine, Karolinska Institutet, Solna, Sweden
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Jose F Huizar
- Cardiology Division, Virginia Commonwealth University/Pauley Heart Center, Richmond, VA, USA
- Cardiology Division, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA, USA
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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.
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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
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Walters TE, Szilagyi J, Alhede C, Sievers R, Fang Q, Olgin J, Gerstenfeld EP. Dyssynchrony and Fibrosis Persist After Resolution of Cardiomyopathy in a Swine Premature Ventricular Contraction Model. JACC Clin Electrophysiol 2020; 6:1367-1376. [PMID: 33121665 DOI: 10.1016/j.jacep.2020.06.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 06/10/2020] [Accepted: 06/12/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES This study sought to prospectively study the development and then regression of premature ventricular contraction (PVC)-induced cardiomyopathy, with the hypothesis that structural left ventricular (LV) changes that are of potential clinical significance may endure beyond the period of exposure to PVCs. BACKGROUND Recovery of LV function after eradication of PVCs in PVC-induced cardiomyopathy is incompletely defined. METHODS Fifteen swine were exposed to: 1) 50% paced PVCs from the LV lateral epicardium for 12 weeks (LV PVC, n = 5); 2) no pacing for 12 weeks (Control, n = 5); or 3) 50% paced LV PVCs for 12 weeks followed by pacing cessation for 4 weeks (Recovery, n = 5). LV function was quantified biweekly in sinus rhythm with echocardiography. Dyssynchrony was measured from pressure-volume loops at baseline and terminal studies. LV fibrosis was quantified after sacrifice. RESULTS LV ejection fraction during sinus rhythm fell between baseline and terminal studies in the LV PVC group (65.8 ± 3.0 to 39.3 ± 3.2; p < 0.05), whereas there was no significant change in the Control group (69.6 ± 3.0 to 72.2 ± 3.0; p = NS) or after Recovery (64.5 ± 3.4% to 61.4 ± 3.4%; p = NS) groups. There was a significant increase in LV dyssynchrony measured during sinus rhythm between baseline and terminal studies in the LV PVC group (4.0 ± 1.5% to 9.0 ± 1.5%; p < 0.05); there was a similar increase in dyssynchrony that persisted 4 weeks after PVC cessation in the Recovery group (4.4 ± 1.7% to 12.8 ± 1.7%; p < 0.05). After sacrifice, percent fibrosis was higher in the LV PVC group compared with Control (5.7 ± 0.3% vs. 3.0 ± 0.3%; p < 0.05) and remained elevated in Recovery (4.1 ± 0.3% vs. 3.0 ± 0.3%; p < 0.05) despite return to baseline LV ejection fraction. CONCLUSIONS In a swine model of PVC-induced cardiomyopathy, cessation of PVCs for 4 weeks leads to normalization of LV systolic function but significant changes in myocardial fibrosis and LV dyssynchrony during sinus rhythm persist.
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Affiliation(s)
- Tomos E Walters
- Section of Cardiac Electrophysiology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Judit Szilagyi
- Section of Cardiac Electrophysiology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Christina Alhede
- Section of Cardiac Electrophysiology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Richard Sievers
- Section of Cardiac Electrophysiology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Qizhi Fang
- Section of Cardiac Electrophysiology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Jeffrey Olgin
- Section of Cardiac Electrophysiology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA.
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Arrhythmia-Induced Cardiomyopathy: JACC State-of-the-Art Review. J Am Coll Cardiol 2020; 73:2328-2344. [PMID: 31072578 DOI: 10.1016/j.jacc.2019.02.045] [Citation(s) in RCA: 170] [Impact Index Per Article: 42.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 02/13/2019] [Accepted: 02/18/2019] [Indexed: 12/26/2022]
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.
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12
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Atrial Failure as a Clinical Entity. J Am Coll Cardiol 2020; 75:222-232. [DOI: 10.1016/j.jacc.2019.11.013] [Citation(s) in RCA: 115] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 10/09/2019] [Accepted: 11/05/2019] [Indexed: 12/16/2022]
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Abstract
AF-mediated cardiomyopathy (AMC) is an important reversible cause of heart failure that is likely underdiagnosed in today’s clinical practice. AMC describes AF either as the sole cause for ventricular dysfunction or exacerbating ventricular dysfunction in patients with existing cardiomyopathy or heart failure. Studies suggest that irreversible ventricular and atrial remodeling can occur in AMC, making timely diagnosis and intervention critical to optimize clinical outcome. Clinical correlation between AF onset/burden and progression of cardiomyopathy/heart failure symptoms provides strong evidence for the diagnosis of AMC. Cardiac MRI, continuous cardiac monitoring, and biomarkers are important diagnostic tools. From the therapeutic standpoint, early data suggest that AF ablation may improve long-term outcomes in AMC patients compared with medical rate and rhythm control. Patients with more AF burden and less severe underlying structural heart disease are more likely to experience left ventricle function recovery with successful AF ablation. Despite recent advances, significant knowledge gaps exist in our understanding of the epidemiology, mechanisms, diagnosis, management strategies, and prognosis of AMC.
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Affiliation(s)
- Dingxin Qin
- Corrigan Minehan Heart Center Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston
| | - Moussa C. Mansour
- Corrigan Minehan Heart Center Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston
| | - Jeremy N. Ruskin
- Corrigan Minehan Heart Center Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston
| | - Edwin Kevin Heist
- Corrigan Minehan Heart Center Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston
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14
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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.
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Affiliation(s)
- Samuel Sossalla
- Department of Internal Medicine II, Cardiology, Pneumology, Intensive Care, University Hospital Regensburg
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15
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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
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16
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Börschel CS, Schnabel RB. The imminent epidemic of atrial fibrillation and its concomitant diseases - Myocardial infarction and heart failure - A cause for concern. Int J Cardiol 2019; 287:162-173. [PMID: 30528622 PMCID: PMC6524760 DOI: 10.1016/j.ijcard.2018.11.123] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 11/19/2018] [Accepted: 11/27/2018] [Indexed: 12/12/2022]
Abstract
Atrial fibrillation (AF) is increasingly common in the general population. It often coincides with myocardial infarction (MI) and heart failure (HF) which are also diseases in older adults. All three conditions share common cardiovascular risk factors. While hypertension and obesity are central risk factors for all three diseases, smoking and diabetes appear to have less impact on AF. To date, age is the single most important risk factor for AF in the general population. Further, epidemiological studies suggest a strong association of AF to MI and HF. The underlying pathophysiological mechanisms are complex and not fully understood. Both MI and HF can trigger development of AF, mainly by promoting structural and electrical atrial remodeling. On the other hand, AF facilitates HF and MI development via multiple mechanisms, resulting in a vicious circle of cardiac impairment and adverse cardiovascular prognosis. Consequently, to prevent and treat the coincidence of AF and HF or MI a strict optimization of cardiovascular risk factors is required.
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Affiliation(s)
- Christin S Börschel
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Renate B Schnabel
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany.
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Arnar DO, Mairesse GH, Boriani G, Calkins H, Chin A, Coats A, Deharo JC, Svendsen JH, Heidbüchel H, Isa R, Kalman JM, Lane DA, Louw R, Lip GYH, Maury P, Potpara T, Sacher F, Sanders P, Varma N, Fauchier L, Haugaa K, Schwartz P, Sarkozy A, Sharma S, Kongsgård E, Svensson A, Lenarczyk R, Volterrani M, Turakhia M, Obel IWP, Abello M, Swampillai J, Kalarus Z, Kudaiberdieva G, Traykov VB, Dagres N, Boveda S, Vernooy K, Kalarus Z, Kudaiberdieva G, Mairesse GH, Kutyifa V, Deneke T, Hastrup Svendsen J, Traykov VB, Wilde A, Heinzel FR. Management of asymptomatic arrhythmias: a European Heart Rhythm Association (EHRA) consensus document, endorsed by the Heart Failure Association (HFA), Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), Cardiac Arrhythmia Society of Southern Africa (CASSA), and Latin America Heart Rhythm Society (LAHRS). Europace 2019; 21:844–845. [DOI: 10.1093/europace/euz046] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 02/24/2019] [Indexed: 12/22/2022] Open
Abstract
AbstractAsymptomatic arrhythmias are frequently encountered in clinical practice. Although studies specifically dedicated to these asymptomatic arrhythmias are lacking, many arrhythmias still require proper diagnostic and prognostic evaluation and treatment to avoid severe consequences, such as stroke or systemic emboli, heart failure, or sudden cardiac death. The present document reviews the evidence, where available, and attempts to reach a consensus, where evidence is insufficient or conflicting.
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Affiliation(s)
- David O Arnar
- Department of Medicine, Landspitali - The National University Hospital of Iceland and University of Iceland, Reykjavik, Iceland
| | | | - Giuseppe Boriani
- Division of Cardiology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Hugh Calkins
- Department of Arrhythmia Services, Johns Hopkins Medical Institutions Baltimore, MD, USA
| | - Ashley Chin
- Division of Cardiology, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Andrew Coats
- Department of Cardiology, University of Warwick, Warwickshire, UK
| | - Jean-Claude Deharo
- Department of Rhythmology, Hôpital Universitaire La Timone, Marseille, France
| | - Jesper Hastrup Svendsen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Hein Heidbüchel
- Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | - Rodrigo Isa
- Clínica RedSalud Vitacura and Hospital el Carmen de Maipú, Santiago, Chile
| | - Jonathan M Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
- Aalborg Thrombosis Research Unit, Aalborg University, Aalborg, Denmark
| | - Ruan Louw
- Department Cardiology (Electrophysiology), Mediclinic Midstream Hospital, Centurion, South Africa
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
- Aalborg Thrombosis Research Unit, Aalborg University, Aalborg, Denmark
| | - Philippe Maury
- Cardiology, University Hospital Rangueil, Toulouse, France
| | - Tatjana Potpara
- Cardiology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Serbia
| | - Frederic Sacher
- Service de Cardiologie, Institut Lyric, CHU de Bordeaux, Bordeaux, France
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Niraj Varma
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Laurent Fauchier
- Service de Cardiologie et Laboratoire d'Electrophysiologie Cardiaque, Centre Hospitalier Universitaire Trousseau et Université François Rabelais, Tours, France
| | - Kristina Haugaa
- Department of Cardiology, Center for Cardiological Innovation and Institute for Surgical Research, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Peter Schwartz
- Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin, Milan, Italy
| | - Andrea Sarkozy
- Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium
| | | | - Erik Kongsgård
- Department of Cardiology, OUS-Rikshospitalet, Oslo, Norway
| | - Anneli Svensson
- Department of Cardiology, University Hospital of Linkoping, Sweden
| | | | | | - Mintu Turakhia
- Stanford University, Cardiac Arrhythmia & Electrophysiology Service, Stanford, USA
| | | | | | - Janice Swampillai
- Electrophysiologist & Cardiologist, Waikato Hospital, University of Auckland, New Zealand
| | - Zbigniew Kalarus
- SMDZ in Zabrze, Medical University of Silesia, Katowice, Poland
- Department of Cardiology, Silesian Center for Heart Diseases, Zabrze
| | | | - Vassil B Traykov
- Department of Invasive Electrophysiology and Cardiac Pacing, Clinic of Cardiology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
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Reverse left ventricular structural remodeling after catheter ablation of atrial fibrillation in patients with preserved left ventricular function: Insights from cardiovascular magnetic resonance native T1 mapping. Heart Rhythm 2019; 16:424-432. [DOI: 10.1016/j.hrthm.2018.09.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Indexed: 11/24/2022]
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19
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Kim DY, Kim SH, Ryu KH. Tachycardia induced Cardiomyopathy. Korean Circ J 2019; 49:808-817. [PMID: 31456374 PMCID: PMC6713829 DOI: 10.4070/kcj.2019.0199] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 07/03/2019] [Indexed: 12/19/2022] Open
Abstract
Recent studies on radiofrequency catheter ablation (RFCA) in atrial fibrillation show its effectiveness in heart failure (HF) patients; hence, tachycardia-induced cardiomyopathy (T-CMP) is gaining attention. Tachycardia-mediated cardiomyopathy is a reversible left ventricular (LV) dysfunction, which can be induced by any tachyarrhythmia. Early recognition of T-CMP with appropriate treatment of the arrhythmia culprit will lead to the recovery of LV function. Patients with tachycardia and LV dysfunction should be suspected of having T-CMP, with or without established etiology of HF, because T-CMP may present by itself or contribute as a co-existent component. Therapeutic options include rate control, anti-arrhythmic drugs, or catheter ablation. Unlike in animal models, clinical data on human T-CMP is limited. Hence, future research should be more focused on tachyarrhythmia-induced cardiomyopathy as its burden is increasing.
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Affiliation(s)
- Do Young Kim
- Cardiovascular Center, Korea University Anam Hospital, Seoul, Korea
| | - Sung Hea Kim
- Division of Cardiology, Department of Medicine, Konkuk University Medical Center, Seoul, Korea
| | - Kyu Hyung Ryu
- Department of Cardiology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea.
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Raymond-Paquin A, Nattel S, Wakili R, Tadros R. Mechanisms and Clinical Significance of Arrhythmia-Induced Cardiomyopathy. Can J Cardiol 2018; 34:1449-1460. [DOI: 10.1016/j.cjca.2018.07.475] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 07/16/2018] [Accepted: 07/27/2018] [Indexed: 12/26/2022] Open
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21
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Montero S, Ferrero-Gregori A, Cinca J, Guerra JM. Long-term Outcome of Patients With Tachycardia-induced Cardiomyopathy After Recovery of Left Ventricular Function. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2018; 71:681-683. [PMID: 28669768 DOI: 10.1016/j.rec.2017.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 04/24/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Santiago Montero
- Servei de Cardiologia, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, CIBERCV, Barcelona, Spain.
| | - Andreu Ferrero-Gregori
- Servei de Cardiologia, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Juan Cinca
- Servei de Cardiologia, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, CIBERCV, Barcelona, Spain
| | - José M Guerra
- Servei de Cardiologia, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, CIBERCV, Barcelona, Spain
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22
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Montero S, Ferrero-Gregori A, Cinca J, Guerra JM. Evolución a largo plazo de pacientes con taquimiocardiopatía tras la recuperación de la función ventricular. Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2017.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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23
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Prognostic value of T1 mapping and extracellular volume fraction in cardiovascular disease: a systematic review and meta-analysis. Heart Fail Rev 2018; 23:723-731. [DOI: 10.1007/s10741-018-9718-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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24
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Diagnostic value of electrocardiographic P-wave characteristics in atrial fibrillation recurrence and tachycardia-induced cardiomyopathy after catheter ablation. Heart Vessels 2018; 33:1381-1389. [DOI: 10.1007/s00380-018-1179-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 04/27/2018] [Indexed: 10/17/2022]
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25
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Ju W, Li M, Wang DW, Yang B, Shao Y, Wang J, Tang L, Ni B, Chen H, Zhang F, Gu K, Yang G, Cui C, Qi R, Xiao F, Fan Q, Wang J, Zhang S, Cao K, Kong X, Feng D, Chen M. Idiopathic isolated fibrotic atrial cardiomyopathy underlies unexplained scar-related atrial tachycardia in younger patients. Europace 2017; 20:1657-1665. [PMID: 29293999 DOI: 10.1093/europace/eux340] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Accepted: 10/19/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Weizhu Ju
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, China
| | - Mingfang Li
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, China
| | - Dao Wu Wang
- The Heart and Lung Institute, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, China
| | - Bing Yang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, China
| | - Yongfeng Shao
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, China
| | - Jiaxian Wang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, China
| | - Lijun Tang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, China
| | - Buqing Ni
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, China
| | - Hongwu Chen
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, China
| | - Fengxiang Zhang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, China
| | - Kai Gu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, China
| | - Gang Yang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, China
| | - Chang Cui
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, China
| | - Rundi Qi
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, China
| | - Fangyi Xiao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, China
| | - Qinhe Fan
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, China
| | - Jie Wang
- Department of Cardiology, Columbia University, New York, NY, USA
| | - Shijiang Zhang
- The Heart and Lung Institute, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, China
| | - Kejiang Cao
- The Heart and Lung Institute, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, China
| | - Xiangqing Kong
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, China
| | - DaLi Feng
- Metropolitan Heart and Vascular Institute, Minneapolis, MN, USA
| | - Minglong Chen
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, China
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Höke U, Khidir MJ, van der Geest RJ, Schalij MJ, Bax JJ, Delgado V, Ajmone Marsan N. Relation of Myocardial Contrast-Enhanced T 1 Mapping by Cardiac Magnetic Resonance to Left Ventricular Reverse Remodeling After Cardiac Resynchronization Therapy in Patients With Nonischemic Cardiomyopathy. Am J Cardiol 2017; 119:1456-1462. [PMID: 28274575 DOI: 10.1016/j.amjcard.2017.01.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 01/23/2017] [Accepted: 01/23/2017] [Indexed: 12/31/2022]
Abstract
Myocardial scar is known to be associated with limited left ventricular (LV) reverse remodeling after cardiac resynchronization therapy (CRT). However, the impact of diffuse myocardial interstitial fibrosis, as assessed with myocardial T1 mapping cardiac magnetic resonance (CMR), has not been studied in patients with CRT. Therefore, we aimed at evaluating the association between diffuse myocardial interstitial fibrosis, in nonischemic cardiomyopathy patients, and LV reverse remodeling after CRT. A total of 40 patients (61 ± 11 years) with nonischemic cardiomyopathy who underwent CMR before CRT implantation were included. Myocardial T1 mapping was performed using an inversion-recovery Look-Locker sequence after gadolinium injection. Myocardial contrast-enhanced T1 time values were assessed from segments without delayed contrast enhancement and normalized for heart rate. At 6-month follow-up, LV reverse remodeling was assessed by the reduction in LV end-systolic volume. Before CRT implantation, mean myocardial contrast-enhanced T1 time was 351 ± 46 ms. At 6-month follow-up, LV end-systolic volume decreased by 24 ± 21%. Myocardial contrast-enhanced T1 time showed a significant correlation with LV reverse remodeling (r = 0.5, p = 0.001) together with hemoglobin level, renal function, LV dyssynchrony, and presence of delayed contrast enhancement. Multivariate regression analysis identified myocardial contrast-enhanced T1 time (β -0.160, p = 0.022), LV dyssynchrony (β -0.267, p = 0.002), and renal function (β -0.334, p = 0.021) as independent associates of LV reverse remodeling. In conclusion, in nonischemic cardiomyopathy, diffuse interstitial myocardial fibrosis quantified with T1 mapping CMR is independently associated with LV reverse remodeling after CRT and might, therefore, be used to optimize patient selection.
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Wong C, Chen S, Iyngkaran P. Cardiac Imaging in Heart Failure with Comorbidities. Curr Cardiol Rev 2017; 13:63-75. [PMID: 27492227 PMCID: PMC5324322 DOI: 10.2174/1573403x12666160803100928] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 06/30/2016] [Accepted: 07/05/2016] [Indexed: 01/19/2023] Open
Abstract
Imaging modalities stand at the frontiers for progress in congestive heart failure (CHF) screening, risk stratification and monitoring. Advancements in echocardiography (ECHO) and Magnetic Resonance Imaging (MRI) have allowed for improved tissue characterizations, cardiac motion analysis, and cardiac performance analysis under stress. Common cardiac comorbidities such as hypertension, metabolic syndromes and chronic renal failure contribute to cardiac remodeling, sharing similar pathophysiological mechanisms starting with interstitial changes, structural changes and finally clinical CHF. These imaging techniques can potentially detect changes earlier. Such information could have clinical benefits for screening, planning preventive therapies and risk stratifying patients. Imaging reports have often focused on traditional measures without factoring these novel parameters. This review is aimed at providing a synopsis on how we can use this information to assess and monitor improvements for CHF with comorbidities.
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Affiliation(s)
- Chiew Wong
- Flinders University, NT Medical School, Darwin Australia
| | - Sylvia Chen
- Flinders University, NT Medical School, Darwin Australia
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Benjamin MM, Chaddha A, Sampene E, Field ME, Rahko PS. Comparison of Outcomes of Atrial Fibrillation in Patients With Reduced Versus Preserved Left Ventricular Ejection Fraction. Am J Cardiol 2016; 118:1831-1835. [PMID: 28029361 DOI: 10.1016/j.amjcard.2016.08.073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 08/30/2016] [Accepted: 08/30/2016] [Indexed: 10/20/2022]
Abstract
Patients with newly diagnosed atrial fibrillation (AF) and a rapid ventricular response may present with a reduced left ventricular ejection fraction (LVEF). We compared long-term outcomes of these patients with those with preserved LVEF. This retrospective cohort study included 385 consecutive adults with newly diagnosed AF with rapid ventricular response, presenting to a single medical center from January 2006 to August 2014. Patients with a history of coronary artery disease or known cardiomyopathy were excluded. Patients were divided into 2 groups: those with an LVEF ≤55% (n = 147) (REF) and those with an LVEF >55% (n = 238) (PEF). Echocardiographic parameters, all-cause mortality, cardiovascular mortality, and stroke rates were compared between both groups at baseline and a minimum of 1-year follow-up. The mean age of patients was 68 ± 1.1 in REF versus 60 ± 7.4 in PEF (p = 0.39). There were no significant differences in baseline co-morbidities between both groups. The mean LVEF during the index admission was 47.7 ± 0.8% in REF versus 65.5 ± 0.3% in PEF. The average duration of follow-up was 2.8 years. Patients with REF had higher all-cause mortality (32.7% REF vs 20.6% PEF, odds ratio 2.17, p = 0.008). Patients with REF had higher rates of subsequent clinic or ER visits for AF with a rapid ventricular response (32% REF vs 22.7% PEF, p = 0.044). The incidence of stroke was similar between both groups (17% REF vs 18.9% PEF, p = 0.639). Of the patients with REF, 64% had subsequent EF recovery and had similar outcomes compared with patients with PEF. Baseline LV end-diastolic diameter predicted all-cause mortality (odds ratio 1.14, p = 0.003) in the REF group. None of the echocardiographic parameters predicted EF recovery. In conclusion, in patients with new AF with rapid ventricular response, REF was associated with higher long-term all-cause mortality. Those with subsequent LVEF recovery after medical therapy appear to have a similar prognosis compared with those with initial PEF.
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Kistler PM, Taylor AJ. Myocardial Strain in the Identification of Tachycardia-Induced Cardiomyopathy: Unscrambling the Egg. JACC Cardiovasc Imaging 2016; 10:127-129. [PMID: 27665166 DOI: 10.1016/j.jcmg.2016.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 03/24/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Peter M Kistler
- Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Australia; Baker IDI Heart and Diabetes Research Institute, Melbourne, Australia; University of Melbourne, Parkville, Australia.
| | - Andrew J Taylor
- Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Australia; Baker IDI Heart and Diabetes Research Institute, Melbourne, Australia; Monash University, Melbourne, Australia
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Montgomery JA, Abdallah W, Yoneda ZT, Brittain E, Aznaurov SG, Parvez B, Adkins K, Whalen SP, Estrada J, Shen S, Crossley GH, Kanagasundram A, Saavedra P, Ellis CR, Lawson M, Darbar D, Shoemaker MB. Measurement of diffuse ventricular fibrosis with myocardial T1 in patients with atrial fibrillation. J Arrhythm 2016; 32:51-6. [PMID: 26949431 PMCID: PMC4759117 DOI: 10.1016/j.joa.2015.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 08/11/2015] [Accepted: 08/24/2015] [Indexed: 11/19/2022] Open
Abstract
Background Atrial fibrillation (AF) is associated with cardiac fibrosis, which can now be measured noninvasively using T1-mapping with cardiac magnetic resonance imaging (CMRI). This study aimed to assess the impact of AF on ventricular T1 at the time of CMRI. Methods Subjects with AF scheduled for AF ablation underwent CMRI with standard electrocardiography gating and breath-hold protocols on a 1.5 T scanner with post-contrast ventricular T1 recorded from 6 regions of interest at the mid-ventricle. Baseline demographic, clinical, and imaging characteristics were examined using univariate and multivariable linear regression modeling for an association with myocardial T1. Results One hundred fifty-seven patients were studied (32% women; median age, 61 years [interquartile range {IQR}, 55–67], 50% persistent AF [episodes>7 days or requiring electrical or pharmacologic cardioversion], 30% in AF at the time of the CMRI). The median global T1 was 404 ms (IQR, 381–428). AF at the time of CMRI was associated with a 4.4% shorter T1 (p=0.000) compared to sinus rhythm when adjusted for age, sex, persistent AF, body mass index, congestive heart failure, and renal dysfunction (estimated glomerular filtration rate<60). A post-hoc multivariate model adjusted for heart rate suggested that heart rate elevation (p=0.009) contributes to the reduction in T1 observed in patients with AF at the time of CMRI. No association between ventricular T1 and AF recurrence after ablation was demonstrated. Conclusion AF at the time of CMRI was associated with lower post-contrast ventricular T1 compared with sinus rhythm. This effect was at least partly due to elevated heart rate. T1 was not associated with the recurrence of AF after ablation.
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Affiliation(s)
- Jay A. Montgomery
- Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA
- Correspondence to: Division of Cardiovascular Medicine, Vanderbilt University, 383 PRB, 2200 Pierce Avenue, Nashville, TN 37232-6300, USA. Tel.: +1 785 577 4575.
| | - Wissam Abdallah
- Spectrum Health Medical Group, 2900 Bradford St NE, Grand Rapids, MI 49525, USA
| | - Zachary T. Yoneda
- Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA
| | - Evan Brittain
- Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA
| | - Sam G. Aznaurov
- Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA
| | - Babar Parvez
- Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA
| | - Keith Adkins
- Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA
| | - S. Patrick Whalen
- Wake Forest Baptist Health Cardiology, 1 Medical Center Blvd, Winston-Salem, NC 27157, USA
| | - J.C. Estrada
- Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA
| | - Sharon Shen
- Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA
| | - George H. Crossley
- Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA
| | - Arvindh Kanagasundram
- Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA
| | - Pablo Saavedra
- Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA
| | - Christopher R. Ellis
- Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA
| | - Mark Lawson
- Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA
| | - Dawood Darbar
- Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA
| | - M. Benjamin Shoemaker
- Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA
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Brembilla-Perrot B, Ferreira JP, Manenti V, Sellal JM, Olivier A, Villemin T, Beurrier D, De Chillou C, Louis P, Brembilla A, Juillière Y, Girerd N. Predictors and prognostic significance of tachycardiomyopathy: insights from a cohort of 1269 patients undergoing atrial flutter ablation. Eur J Heart Fail 2016; 18:394-401. [DOI: 10.1002/ejhf.482] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 11/14/2015] [Accepted: 12/05/2015] [Indexed: 11/11/2022] Open
Affiliation(s)
| | - João Pedro Ferreira
- INSERM, Centre d'Investigations Cliniques Plurithématique 1433; Université de Lorraine; CHRU de Nancy and F-CRIN INI-CRCT Nancy France
- Department of Physiology and Cardiothoracic Surgery, Cardiovascular Research and Development Unit, Faculty of Medicine; University of Porto; Porto Portugal
| | - Vladimir Manenti
- Department of Cardiology Nancy University Hospital; Rue du Morvan 54511 Vandoeuvre-les-Nancy France
| | - Jean Marc Sellal
- Department of Cardiology Nancy University Hospital; Rue du Morvan 54511 Vandoeuvre-les-Nancy France
| | - Arnaud Olivier
- Department of Cardiology Nancy University Hospital; Rue du Morvan 54511 Vandoeuvre-les-Nancy France
| | - Thibaut Villemin
- Department of Cardiology Nancy University Hospital; Rue du Morvan 54511 Vandoeuvre-les-Nancy France
| | - Daniel Beurrier
- Department of Cardiology Nancy University Hospital; Rue du Morvan 54511 Vandoeuvre-les-Nancy France
| | - Christian De Chillou
- Department of Cardiology Nancy University Hospital; Rue du Morvan 54511 Vandoeuvre-les-Nancy France
| | - Pierre Louis
- Department of Cardiology Nancy University Hospital; Rue du Morvan 54511 Vandoeuvre-les-Nancy France
| | | | - Yves Juillière
- Department of Cardiology Nancy University Hospital; Rue du Morvan 54511 Vandoeuvre-les-Nancy France
| | - Nicolas Girerd
- INSERM, Centre d'Investigations Cliniques Plurithématique 1433; Université de Lorraine; CHRU de Nancy and F-CRIN INI-CRCT Nancy France
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Gopinathannair R, Etheridge SP, Marchlinski FE, Spinale FG, Lakkireddy D, Olshansky B. Arrhythmia-Induced Cardiomyopathies: Mechanisms, Recognition, and Management. J Am Coll Cardiol 2016; 66:1714-28. [PMID: 26449143 DOI: 10.1016/j.jacc.2015.08.038] [Citation(s) in RCA: 206] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 07/28/2015] [Accepted: 08/17/2015] [Indexed: 12/19/2022]
Abstract
Arrhythmia-induced cardiomyopathy (AIC) is a potentially reversible condition in which left ventricular dysfunction is induced or mediated by atrial or ventricular arrhythmias. Cellular and extracellular changes in response to the culprit arrhythmia have been identified, but specific pathophysiological mechanisms remain unclear. Early recognition of AIC and prompt treatment of the culprit arrhythmia using pharmacological or ablative techniques result in symptom resolution and recovery of ventricular function. Although cardiomyopathy in response to an arrhythmia may take months to years to develop, recurrent arrhythmia can result in rapid decline in ventricular function with development of heart failure, suggesting residual ultrastructural abnormalities. Reports of sudden death in patients with normalized left ventricular ejection fraction cast doubt on the complete reversibility of this condition. Several aspects of AIC, including specific pathophysiological mechanisms, predisposing factors, optimal therapeutic strategies to prevent ultrastructural changes, and long-term risk of sudden death remain unresolved and need further research.
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Affiliation(s)
- Rakesh Gopinathannair
- Division of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky.
| | - Susan P Etheridge
- Division of Pediatric Cardiology, University of Utah, Salt Lake City, Utah
| | | | - Francis G Spinale
- Department of Internal Medicine, University of South Carolina, Charleston, South Carolina
| | | | - Brian Olshansky
- Mercy Heart and Vascular Institute, Mercy Medical Center North Iowa, Mason City, Iowa
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Basuray A, Fang JC. Management of Patients With Recovered Systolic Function. Prog Cardiovasc Dis 2016; 58:434-43. [PMID: 26796969 DOI: 10.1016/j.pcad.2016.01.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 01/10/2016] [Indexed: 11/25/2022]
Abstract
Advancements in the treatment of heart failure (HF) with systolic dysfunction have given rise to a new population of patients with improved ejection fraction (EF). The management of this distinct population is not well described due to a lack of consensus on the definition of myocardial recovery, a scarcity of data on the natural history of these patients, and the absence of focused clinical trials. Moreover, an improvement in EF may have different prognostic and management implications depending on the underlying etiology of cardiomyopathy. This can be challenging for the clinician who is approached by a patient inquiring about a reduction of medical therapy after apparent EF recovery. This review explores management strategies for HF patients with recovered EF in a disease-specific format.
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Okada A, Nakajima I, Morita Y, Inoue YY, Kamakura T, Wada M, Ishibashi K, Miyamoto K, Okamura H, Nagase S, Noda T, Aiba T, Kamakura S, Anzai T, Noguchi T, Yasuda S, Kusano K. Diagnostic Value of Right Ventricular Dysfunction in Tachycardia-Induced Cardiomyopathy Using Cardiac Magnetic Resonance Imaging. Circ J 2016; 80:2141-8. [DOI: 10.1253/circj.cj-16-0532] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Atsushi Okada
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
- Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | - Ikutaro Nakajima
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yoshiaki Morita
- Department of Radiology, National Cerebral and Cardiovascular Center
| | - Yuko Y. Inoue
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Tsukasa Kamakura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Mitsuru Wada
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kohei Ishibashi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Koji Miyamoto
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hideo Okamura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Satoshi Nagase
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Takeshi Aiba
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Shiro Kamakura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
- Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
- Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
- Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
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Abstract
Atrial fibrillation (AF) and heart failure (HF) are evolving epidemics, together responsible for substantial human suffering and health-care expenditure. Ageing, improved cardiovascular survival, and epidemiological transition form the basis for their increasing global prevalence. Although we now have a clear picture of how HF promotes AF, gaps remain in our knowledge of how AF exacerbates or even causes HF, and how the development of HF affects the outcome of patients with AF. New data regarding HF with preserved ejection fraction and its unique relationship with AF suggest a possible role for AF in its aetiology, possibly as a trigger for ventricular fibrosis. Deciding on optimal treatment strategies for patients with both AF and HF is increasingly difficult, given that results from trials of pharmacological rhythm control are arguably obsolete in the age of catheter ablation. Restoring sinus rhythm by catheter ablation seems successful in the medium term and improves HF symptoms, functional capacity, and left ventricular function. Long-term studies to examine the effect on rates of stroke and death are ongoing. Guidelines continue to evolve to keep pace with this rapidly changing field.
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36
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Yamaguchi Y, Sohara H, Takeda H, Nakamura Y, Ihara M, Higuchi S, Satake S. Long-Term Results of Radiofrequency Hot Balloon Ablation in Patients With Paroxysmal Atrial Fibrillation: Safety and Rhythm Outcomes. J Cardiovasc Electrophysiol 2015; 26:1298-306. [PMID: 26331460 DOI: 10.1111/jce.12820] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Revised: 08/20/2015] [Accepted: 08/25/2015] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Isolation of pulmonary veins (PVs) and the posterior left atrium (LA) can be safely performed by radiofrequency hot balloon (RHB)-based box isolation. However, data on long-term effects for the treatment of atrial fibrillation (AF) by the use of this method remain limited. METHODS AND RESULTS We treated 238 patients with paroxysmal AF (194 male; age. 62.6 ± 9.4 years) by RHB ablation. During 6.2-year (75 months) follow-up, 154 (64.7%) patients were free from atrial tachyarrhythmias (ATAs) without antiarrhythmic-drugs (AADs). We performed re-ablation in 69 of 84 patients with ATA recurrence (average 1.3 ± 0.6; median 1, total 91 procedures) using a 3D-mapping system and a conventional catheter. The sites of reconnection were observed at the PV in 61 of 69 (88.4%) patients and at the posterior LA in 58 of 69 (84.1%) patients. Finally, during mean follow-up of 4.6 ± 1.6 years, no-ATA episodes were detected in 201 (84.5%) patients without AADs. Independent predictors of ATA recurrence following a single procedure were heart failure with preserved ejection fraction (HR: 2.67, 95%CI: 1.40-5.10, P = 0.003) and low estimated glomerular filtration rate (HR: 1.81, 95%CI: 1.11-2.93, P = 0.03; cut-off of 62.0 mL/min/1.73 m(2)). During the follow-up period, there were 4 (1.7%) patients with PV stenosis (>70% reduction in PV diameter); however, none of these cases required intervention. Phrenic nerve palsy was detected in 8 patients (3.4%), but resolved during 3 months in all cases. CONCLUSION RHB ablation can be effective during a long-term follow-up for patients with paroxysmal AF. Safety outcomes were within an acceptable range.
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Affiliation(s)
| | - Hiroshi Sohara
- Heart Rhythm Center, Hayama Heart Center, Kanagawa, Japan
| | - Hiroshi Takeda
- Heart Rhythm Center, Hayama Heart Center, Kanagawa, Japan
| | | | - Minoru Ihara
- Heart Rhythm Center, Hayama Heart Center, Kanagawa, Japan
| | | | - Shutaro Satake
- Heart Rhythm Center, Hayama Heart Center, Kanagawa, Japan
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Vallurupalli S, Pothineni NVK, Deshmukh A, Paydak H. Utility of Routine Exercise Testing to Detect Rate-Related QRS Widening in Patients Without Structural Heart Disease on Class Ic Antiarrhythmic Agents (Flecainide and Propafenone). Am J Cardiol 2015; 116:730-2. [PMID: 26100588 DOI: 10.1016/j.amjcard.2015.05.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 05/20/2015] [Accepted: 05/20/2015] [Indexed: 10/23/2022]
Abstract
Class Ic antiarrhythmic agents are effective in the treatment of various atrial tachyarrhythmias. They are known to cause rate-related QRS widening in the presence of structural heart disease, which can lead to life-threatening arrhythmias. The role of routine exercise electrocardiography in patients without structural heart disease is unknown. All patients initiated on class Ic antiarrhythmic agents and who had exercise electrocardiography performed from June 2009 to June 2013 were included. Symptom-limited treadmill electrocardiography was performed to detect significant QRS widening at peak exercise (defined as an increase of >25% of baseline QRS). Fifty-six patients were included in the study. All patients were screened for structural heart disease before initiation of the medication. Significant QRS widening and atrial tachycardia occurred in a single patient, which terminated with cessation of exercise. This patient had a history of tachycardia-mediated cardiomyopathy with normalization of ejection fraction 3 years before being placed on flecainide. In conclusion, routine exercise testing to detect QRS widening is not warranted in patients with no structural heart disease.
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Patel H, Madanieh R, Kosmas CE, Vatti SK, Vittorio TJ. Reversible Cardiomyopathies. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2015; 9:7-14. [PMID: 26052233 PMCID: PMC4441366 DOI: 10.4137/cmc.s19703] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 01/12/2015] [Accepted: 01/17/2015] [Indexed: 01/04/2023]
Abstract
Cardiomyopathies (CMs) have many etiological factors that can result in severe structural and functional dysregulation. Fortunately, there are several potentially reversible CMs that are known to improve when the root etiological factor is addressed. In this article, we discuss several of these reversible CMs, including tachycardia-induced, peripartum, inflammatory, hyperthyroidism, Takotsubo, and chronic illness-induced CMs. Our discussion also includes a review on their respective pathophysiology, as well as possible management solutions.
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Affiliation(s)
- Harsh Patel
- SUNY Downstate School of Medicine, Department of Internal Medicine, Brooklyn, NY, USA
| | - Raef Madanieh
- St. Francis Hospital - The Heart Center , Center for Advanced Cardiac Therapeutics, Roslyn, NY, USA
| | - Constantine E Kosmas
- Mount Sinai School of Medicine, Zena and Michael A. Wiener Cardiovascular Institute, New York, NY, USA
| | - Satya K Vatti
- St. Francis Hospital - The Heart Center , Center for Advanced Cardiac Therapeutics, Roslyn, NY, USA
| | - Timothy J Vittorio
- St. Francis Hospital - The Heart Center , Center for Advanced Cardiac Therapeutics, Roslyn, NY, USA
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Abstract
Tachycardia, conventionally, but arbitrarily, defined as an atrial and/or ventricular rate of >100 beats per minute, is encountered commonly and can be physiological or pathological in origin. Various adverse consequences from tachycardia have been recognized, and an important one is the association between persistent tachycardia and cardiomyopathy. In this article, we provide an up-to-date review on the etiology of tachycardia, management strategies, and the prognosis of patients presenting with tachycardia and cardiomyopathy.
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Affiliation(s)
- Rakesh Gopinathannair
- Division of Cardiovascular Medicine, University of Louisville School of MedicineACB/A3L41, 550 So. Jackson St., Louisville, KYUSA
| | - Brian Olshansky
- University of Iowa Hospitals and Clinics200 Hawkins Dr, Iowa City, IAUSA
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40
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Abstract
Patients with dilated cardiomyopathies (DCM) face a significant burden of arrhythmias, including conduction defects such as atrioventricular block and interventricular delay in the form of left bundle branch block, resulting in altered electromechanical coupling that can exacerbate heart failure. Atrial fibrillation is common and carries an adverse prognosis. Ventricular arrhythmias and sudden cardiac death generally occur late in the disease course. Sustained monomorphic ventricular tachycardia accounts for most of the sustained ventricular arrhythmias in DCM. This article summarizes common forms of arrhythmias encountered in patients with DCM, and reviews the relevant electrophysiologic basis of these arrhythmias and their management.
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Affiliation(s)
- Saurabh Kumar
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - William G Stevenson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Roy M John
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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41
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Bulluck H, Maestrini V, Rosmini S, Abdel-Gadir A, Treibel TA, Castelletti S, Bucciarelli-Ducci C, Manisty C, Moon JC. Myocardial T1 mapping. Circ J 2015; 79:487-94. [PMID: 25746524 DOI: 10.1253/circj.cj-15-0054] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Cardiovascular magnetic resonance is a well-established tool for the quantification of focal fibrosis. With the introduction of T1 mapping, diffuse myocardial processes can be detected and quantified. In particular, infiltration and storage disorders with large disease-related changes, and diffuse fibrosis where measurement is harder but the potential impact larger. This has added a new dimension to the understanding and assessment of various myocardial diseases. T1 mapping promises to detect early disease, quantify disease severity and provide prognostic insights into certain conditions. It also has the potential to be a robust surrogate marker in drug development trials to monitor therapeutic response and be a prognostic marker in certain diseases. T1 mapping is an evolving field and numerous factors currently preclude its standardization. In this review, we describe the current status of T1 mapping and its potential promises and pitfalls.
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Affiliation(s)
- Heerajnarain Bulluck
- Heart Hospital Imaging Centre, Barts Heart Centre; Hatter Cardiovascular Institute, University College London
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42
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Abstract
Atrial fibrillation (AF) is the most common sustained clinical arrhythmia and is associated with significant morbidity, mostly secondary to heart failure and stroke, and an estimated two-fold increase in premature death. Efforts to increase our understanding of AF and its complications have focused on unravelling the mechanisms of electrical and structural remodelling of the atrial myocardium. Yet, it is increasingly recognized that AF is more than an atrial disease, being associated with systemic inflammation, endothelial dysfunction, and adverse effects on the structure and function of the left ventricular myocardium that may be prognostically important. Here, we review the molecular and in vivo evidence that underpins current knowledge regarding the effects of human or experimental AF on the ventricular myocardium. Potential mechanisms are explored including diffuse ventricular fibrosis, focal myocardial scarring, and impaired myocardial perfusion and perfusion reserve. The complex relationship between AF, systemic inflammation, as well as endothelial/microvascular dysfunction and the effects of AF on ventricular calcium handling and oxidative stress are also addressed. Finally, consideration is given to the clinical implications of these observations and concepts, with particular reference to rate vs. rhythm control.
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Affiliation(s)
- Rohan S Wijesurendra
- Division of Cardiovascular Medicine, BHF Centre of Research Excellence, University of Oxford, John Radcliffe Hospital, Level 6 West Wing, Oxford OX3 9DU, UK
| | - Barbara Casadei
- Division of Cardiovascular Medicine, BHF Centre of Research Excellence, University of Oxford, John Radcliffe Hospital, Level 6 West Wing, Oxford OX3 9DU, UK
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Ventricular arrhythmias in patients with heart failure secondary to reduced ejection fraction: a current perspective. Curr Opin Cardiol 2014; 29:152-9. [PMID: 24378634 DOI: 10.1097/hco.0000000000000035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To review the management of ventricular arrhythmias in patients with heart failure secondary to reduced ejection fraction (HFrEF). RECENT FINDINGS Recurrent ventricular arrhythmias and automatic implantable cardioverter defibrillator (AICD) shocks are responsible for significant mortality and morbidity in patients with HFrEF. Antiarrhythmic drugs and catheter ablation are the main treatment options. Frequent premature ventricular contractions (PVCs; >10,000-20,000/24-h period) are being recognized as a cause of cardiomyopathy and suboptimal response to cardiac resynchronization therapy (CRT). Patients with ventricular assist devices (VADs) have frequent ventricular tachyarrhythmias resulting in increased morbidity and mortality. Such patients may need continuation of active ICD therapy and adjunctive catheter ablation. SUMMARY There is a pressing need to develop new antiarrhythmic drugs to treat patients with recurrent AICD shocks. The effectiveness of catheter ablation as first-line therapy for preventing ventricular arrhythmias and recurrent AICD shocks needs to be directly compared with amiodarone. Ventricular tachyarrhythmias are common in CRT patients and patients with VADs. Frequent PVCs may result in a reversible form of HFrEF.
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Iles LM, Slavin GS, Taylor AJ. T1 Mapping in Heart Failure. CURRENT CARDIOVASCULAR IMAGING REPORTS 2014. [DOI: 10.1007/s12410-014-9282-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Jellis CL, Kwon DH. Myocardial T1 mapping: modalities and clinical applications. Cardiovasc Diagn Ther 2014; 4:126-37. [PMID: 24834410 PMCID: PMC3996234 DOI: 10.3978/j.issn.2223-3652.2013.09.03] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 09/13/2013] [Indexed: 12/17/2022]
Abstract
Myocardial fibrosis appears to be linked to myocardial dysfunction in a multitude of non-ischemic cardiomyopathies. Accurate non-invasive quantitation of this extra-cellular matrix has the potential for widespread clinical benefit in both diagnosis and guiding therapeutic intervention. T1 mapping is a cardiac magnetic resonance (CMR) imaging technique, which shows early clinical promise particularly in the setting of diffuse fibrosis. This review will outline the evolution of T1 mapping and the various techniques available with their inherent advantages and limitations. Histological validation of this technique remains somewhat limited, however clinical application in a range of pathologies suggests strong potential for future development.
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Gupta S, Figueredo VM. Tachycardia mediated cardiomyopathy: Pathophysiology, mechanisms, clinical features and management. Int J Cardiol 2014; 172:40-6. [DOI: 10.1016/j.ijcard.2013.12.180] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 12/23/2013] [Accepted: 12/30/2013] [Indexed: 11/25/2022]
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Mohmand-Borkowski A, Tang WHW. Atrial fibrillation as manifestation and consequence of underlying cardiomyopathies: from common conditions to genetic diseases. Heart Fail Rev 2014; 19:295-304. [DOI: 10.1007/s10741-014-9424-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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