1
|
Akpoviroro O, Sauers NK, Uwandu Q, Castagne M, Akpoviroro OP, Humayun S, Mirza W, Woodard J. Severe COVID-19 infection: An institutional review and literature overview. PLoS One 2024; 19:e0304960. [PMID: 39163410 PMCID: PMC11335168 DOI: 10.1371/journal.pone.0304960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 05/21/2024] [Indexed: 08/22/2024] Open
Abstract
BACKGROUND Our study aimed to describe the group of severe COVID-19 patients at an institutional level, and determine factors associated with different outcomes. METHODS A retrospective chart review of patients admitted with severe acute hypoxic respiratory failure due to COVID-19 infection. Based on outcomes, we categorized 3 groups of severe COVID-19: (1) Favorable outcome: progressive care unit admission and discharge (2) Intermediate outcome: ICU care (3) Poor outcome: in-hospital mortality. RESULTS Eighty-nine patients met our inclusion criteria; 42.7% were female. The average age was 59.7 (standard deviation (SD):13.7). Most of the population were Caucasian (95.5%) and non-Hispanic (91.0%). Age, sex, race, and ethnicity were similar between outcome groups. Medicare and Medicaid patients accounted for 62.9%. The average BMI was 33.5 (SD:8.2). Moderate comorbidity was observed, with an average Charlson Comorbidity index (CCI) of 3.8 (SD:2.6). There were no differences in the average CCI between groups(p = 0.291). Many patients (67.4%) had hypertension, diabetes (42.7%) and chronic lung disease (32.6%). A statistical difference was found when chronic lung disease was evaluated; p = 0.002. The prevalence of chronic lung disease was 19.6%, 27.8%, and 40% in the favorable, intermediate, and poor outcome groups, respectively. Smoking history was associated with poor outcomes (p = 0.04). Only 7.9% were fully vaccinated. Almost half (46.1%) were intubated and mechanically ventilated. Patients spent an average of 12.1 days ventilated (SD:8.5), with an average of 6.0 days from admission to ventilation (SD:5.1). The intermediate group had a shorter average interval from admission to ventilator (77.2 hours, SD:67.6), than the poor group (212.8 hours, SD:126.8); (p = 0.001). The presence of bacterial pneumonia was greatest in the intermediate group (72.2%), compared to the favorable group (17.4%), and the poor group (56%); this was significant (p<0.0001). In-hospital mortality was seen in 28.1%. CONCLUSION Most patients were male, obese, had moderate-level comorbidity, a history of tobacco abuse, and government-funded insurance. Nearly 50% required mechanical ventilation, and about 28% died during hospitalization. Bacterial pneumonia was most prevalent in intubated groups. Patients who were intubated with a good outcome were intubated earlier during their hospital course, with an average difference of 135.6 hours. A history of cigarette smoking and chronic lung disease were associated with poor outcomes.
Collapse
Affiliation(s)
- Ogheneyoma Akpoviroro
- Department of Internal Medicine, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, Pennsylvania, United States of America
| | - Nathan Kyle Sauers
- Department of Engineering, Pennsylvania State University, State College, Pennsylvania, United States of America
| | - Queeneth Uwandu
- Department of Internal Medicine, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, Pennsylvania, United States of America
| | - Myriam Castagne
- Clinical & Translational Science Institute, Boston University, Boston, Massachusetts, United States of America
| | | | - Sara Humayun
- Department of Internal Medicine, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, Pennsylvania, United States of America
| | - Wasique Mirza
- Department of Internal Medicine, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, Pennsylvania, United States of America
| | - Jameson Woodard
- Department of Internal Medicine, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, Pennsylvania, United States of America
| |
Collapse
|
2
|
Yasumoto K, Egami Y, Nohara H, Kawanami S, Sugae H, Ukita K, Kawamura A, Nakamura H, Tsuda M, Okamoto N, Matsunaga-Lee Y, Yano M, Nishino M, Tanouchi J. Risk factors for tachycardia-induced cardiomyopathy due to atrial fibrillation. Pacing Clin Electrophysiol 2024; 47:1073-1078. [PMID: 39031769 DOI: 10.1111/pace.15026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/02/2024] [Accepted: 05/30/2024] [Indexed: 07/22/2024]
Abstract
BACKGROUND Tachycardia-induced cardiomyopathy (TIC) is a reversible cardiomyopathy with ventricular dysfunction caused by tachyarrhythmias. Notably, atrial fibrillation (AF) is the most common causal arrhythmia leading to TIC. However, the risk factors for the development of TIC due to AF remain unclear. This study aimed to identify the associated factors of TIC due to AF. METHODS Persistent AF patients with heart rate (HR) ≥100 beats per minute who underwent initial catheter ablation were enrolled in this study. TIC was diagnosed as left ventricular ejection fraction (LVEF) < 50% during AF rhythm, which was recovered after the restoration of sinus rhythm. Non-TIC was defined as LVEF ≥ 50% despite AF rhythm. The patient backgrounds were compared between the TIC group and the non-TIC group to reveal the contributing factors of TIC. RESULTS The TIC group comprised 57 patients, while the non-TIC group consisted of 101 patients. The TIC group was younger than the non-TIC group (median 64 vs. 70, p = 0.006). Male sex was more frequent in the TIC group than the non-TIC group (82.5% vs. 58.4%, p = 0.003). HR was higher in the TIC group than in the non-TIC group (median 130 bpm vs. 111 bpm, p < 0.001). The number of smokers was significantly higher in the TIC group than in the non-TIC group (p < 0.001). Multivariable analysis demonstrated that higher HR (odds ratio [OR]: 1.74; 95% confidence interval [CI]: 1.37-2.21; p < 0.001) and current smokers (OR: 5.27; 95% CI: 1.60-17.4; p = 0.006) were the independent factors leading to TIC. CONCLUSION Higher HR and current smokers were independent risk factors for the development of TIC due to AF.
Collapse
Affiliation(s)
- Koji Yasumoto
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Yasuyuki Egami
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Hiroaki Nohara
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Shodai Kawanami
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Hiroki Sugae
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Kohei Ukita
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Akito Kawamura
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Hitoshi Nakamura
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Masaki Tsuda
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Naotaka Okamoto
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | | | - Masamichi Yano
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Masami Nishino
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Jun Tanouchi
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| |
Collapse
|
3
|
Triska J, Tamargo J, Bozkurt B, Elkayam U, Taylor A, Birnbaum Y. An Updated Review on the Role of Non-dihydropyridine Calcium Channel Blockers and Beta-blockers in Atrial Fibrillation and Acute Decompensated Heart Failure: Evidence and Gaps. Cardiovasc Drugs Ther 2023; 37:1205-1223. [PMID: 35357604 DOI: 10.1007/s10557-022-07334-y] [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] [Accepted: 03/24/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE The 2021 European Society of Cardiology guidelines on acute and chronic heart failure (HF) recommend that non-dihydropyridine calcium channel blockers (NDCC) should be avoided in patients with HF with reduced ejection fraction. It also emphasizes that beta-blockers only be initiated in clinically stable, euvolemic patients. Despite these recommendations, NDCC and beta-blockers are often still employed in patients with AF with rapid ventricular response and acute decompensated HF. The relative safety and efficacy of these therapies in this setting is unclear. METHODS To address the question of the safety and efficacy of NDCC and beta-blockers for acute rate control in decompensated HF, we provide a perspective on the literature of NDCC and beta-blockers in chronic HF with reduced and preserved ejection fraction and AF, including trials on the management of AF with rapid ventricular response with and without HF. RESULTS Robust data demonstrates mortality benefits when beta-blockers are used in patients with chronic HF with reduced ejection fraction. The data that inform the contraindication of NDCC in HF with reduced ejection fraction are outdated and were not primarily designed to address the efficacy and safety of rate control of AF in patients with HF. Several studies indicate that for acute rate control, NDCC and beta-blockers are both efficacious therapies, especially in the setting of tachycardia-induced cardiomyopathy. CONCLUSION Future studies are needed to assess the safety and efficacy of beta-blockers and NDCC in both acute and chronic AF with HF with reduced and preserved ejection fraction.
Collapse
Affiliation(s)
- Jeffrey Triska
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
| | - Juan Tamargo
- Department of Pharmacology and Toxicology School of Medicine, Institute Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | - Biykem Bozkurt
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - Uri Elkayam
- Department of Medicine, Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Addison Taylor
- Department of Medicine, Division of Hypertension and Clinical Pharmacology, Baylor College of Medicine, Houston, TX, USA
| | - Yochai Birnbaum
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
4
|
Leach KS, Rivera S, Devlin W, Kutinsky I, Boyd R, Danforth MD, Rapoport G, Yakubinis L, McManamon R, McHale B, Murphy HW. MANAGEMENT OF ATRIAL FIBRILLATION, VENTRICULAR ARRHYTHMIA, LEFT VENTRICULAR DYSFUNCTION, AND SUBSEQUENT CARDIOPATHOLOGIC EVALUATION IN AN ORANGUTAN ( PONGO PYGMAEUS × ABELII). J Zoo Wildl Med 2023; 54:406-411. [PMID: 37428707 DOI: 10.1638/2022-0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2022] [Indexed: 07/12/2023] Open
Abstract
A 37-yr-old male vasectomized hybrid orangutan (Pongo pygmaeus × abelii) was diagnosed with left ventricular dysfunction during a preventative health care examination. Treatment was initiated with carvedilol. The following year, this orangutan was evaluated for intermittent lethargy. Following observation of an irregular cardiac rhythm during an echocardiogram, a lead II electrocardiogram revealed atrial fibrillation and ventricular arrhythmia. Additional treatment included amiodarone, furosemide, spironolactone, clopidogrel, and aspirin. An improved activity level was noted, and follow-up testing showed restoration of a sinus rhythm, reduced frequency of ventricular arrhythmia, and improved left ventricular function. The orangutan died 27 mon after initial diagnosis of heart disease, and a complete necropsy was performed. This article describes successful diagnosis and management of structural and arrhythmic heart disease in an orangutan, emphasizing the role of cardiac disease screening and behavioral training in apes, as well as the value of matching thorough antemortem and postmortem cardiac evaluation.
Collapse
Affiliation(s)
| | | | - William Devlin
- Oakland University William Beaumont School of Medicine, Rochester, MI 48309, USA
| | - Ilana Kutinsky
- Oakland University William Beaumont School of Medicine, Rochester, MI 48309, USA
| | - Roberta Boyd
- Sibley Heart Center Cardiology, Atlanta, GA 30341, USA
| | | | - Gregg Rapoport
- Department of Small Animal Medicine and Surgery, University of Georgia, College of Veterinary Medicine, Athens, GA 30602, USA
| | | | - Rita McManamon
- Zoo and Exotic Animal Pathology Service, Infectious Diseases Laboratory, University of Georgia, College of Veterinary Medicine, Athens, GA 30602, USA
- Department of Pathology, University of Georgia, College of Veterinary Medicine, Athens, GA 30602, USA
| | - Brittany McHale
- Zoo and Exotic Animal Pathology Service, Infectious Diseases Laboratory, University of Georgia, College of Veterinary Medicine, Athens, GA 30602, USA
| | | |
Collapse
|
5
|
Yamashita A, Kiuchi S, Ikeda T. A Case of Non-Tachycardic Atrial Fibrillation Whose Left Ventricular Systolic Dysfunction Improved After Catheter Ablation. J Clin Med Res 2023; 15:274-278. [PMID: 37303466 PMCID: PMC10251699 DOI: 10.14740/jocmr4908] [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: 03/15/2023] [Accepted: 04/29/2023] [Indexed: 06/13/2023] Open
Abstract
It is difficult to identify the causes and optimal treatment of heart failure (HF) in patients with atrial fibrillation (AF) and HF with reduced ejection fraction (EF) (HFrEF). Tachyarrhythmia can cause left ventricular (LV) systolic dysfunction called tachycardia-induced cardiomyopathy (TIC). In patients with TIC, conversion to sinus rhythm may lead to improvement in LV systolic dysfunction. However, it is unclear whether we should try to convert patients with AF without tachycardia to sinus rhythm. A 46-year-old man with chronic AF and HFrEF came to our hospital. His New York Heart Association (NYHA) classification was class II. The blood test showed a brain natriuretic peptide of 105 pg/mL. Electrocardiogram (ECG) and 24-h ECG showed AF without tachycardia. Transthoracic echocardiography (TTE) showed left atrial (LA) dilatation, LV dilatation, and diffuse LV hypokinesis (EF was 40%). Although he was optimized medically, NYHA classification II persisted. Therefore, he underwent direct current cardioversion and catheter ablation. After his AF converted to a sinus rhythm of heart rate (HR) 60 - 70 beats per minute (bpm), TTE showed improvement in LV systolic dysfunction. We gradually reduced oral medications for arrhythmia and HF. We subsequently succeeded in discontinuing all medications 1 year after catheter ablation. TTE performed between 1 and 2 years after catheter ablation showed normal LV function and normal cardiac size. During the 3 years of follow-up, there was no recurrence of AF, and he was not readmitted to the hospital. This patient showed the effectiveness of converting AF to sinus rhythm in patients without tachycardia.
Collapse
Affiliation(s)
- Asami Yamashita
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine, Ota-ku, Tokyo 143-8541, Japan
| | - Shunsuke Kiuchi
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Ota-ku, Tokyo 143-8541, Japan
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Ota-ku, Tokyo 143-8541, Japan
| |
Collapse
|
6
|
Ermert L, Kreimer F, Quast DR, Pflaumbaum A, Mügge A, Gotzmann M. Rate of atrial fibrillation and flutter induced tachycardiomyopathy in a cohort of hospitalized patients with heart failure and detection of indicators for improved diagnosis. Front Cardiovasc Med 2023; 9:940060. [PMID: 36712260 PMCID: PMC9878112 DOI: 10.3389/fcvm.2022.940060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 12/30/2022] [Indexed: 01/13/2023] Open
Abstract
Background Atrial fibrillation (AF) and atrial flutter (AFL) induced tachycardiomyopathy (TCM) has been known to cause reversible heart failure (HF) for many years. However, the prevalence of the disease is unknown, and diagnosis is challenging. Therefore, the aim of the present study was (1) to assess the rate of AF/AFL induced TCM and (2) to identify indicators for diagnosis. Methods Consecutively, all patients with a diagnosis of HF who were hospitalized in our department within 12 months were reviewed. For the main analysis, all patients with HF with reduced ejection fraction (HFrEF) and AF or AFL were included. AF/AFL induced TCM was diagnosed when there was at least a 10% improvement in left ventricular ejection fraction under rhythm or rate control within 3 months. Patients with HFrEF with AF/AFL but without TCM served as control group. Results A total of 480 patients were included. AF/AFL induced TCM occurred in 26 patients (5.4%) and HFrEF with AF/AFL in 53 patients (11%). Independent indicators of AF/AFL induced TCM were age<79 years [Odds ratio 5.887, confidence interval (CI) 1.999-17.339, p < 0.001], NT-pro-BNP <5,419 pg/mL (Odds ratio 2.327, CI 1.141-4.746, p = 0.004), and a resting heart rate >112 bpm (Odds ratio 2.503, CI 1.288-4.864, p = 0.001). Conclusion Approximately 5% of all patients hospitalized for HF suffer from AF/AFL induced TCM. Improved discrimination of AF/AFL induced TCM to HFrEF with AF/AFL is possible considering age, NT-pro-BNP level, and resting heart rate >112 beats/minute. Based on these parameters, an earlier diagnosis and improved therapy might be possible.
Collapse
Affiliation(s)
- Lynn Ermert
- University Hospital St. Josef-Hospital Bochum, Cardiology and Rhythmology, Ruhr-University Bochum, Bochum, Germany
| | - Fabienne Kreimer
- University Hospital St. Josef-Hospital Bochum, Cardiology and Rhythmology, Ruhr-University Bochum, Bochum, Germany
| | - Daniel R. Quast
- University Hospital St. Josef-Hospital Bochum, Internal Medicine, Ruhr-University Bochum, Bochum, Germany
| | - Andreas Pflaumbaum
- University Hospital St. Josef-Hospital Bochum, Cardiology and Rhythmology, Ruhr-University Bochum, Bochum, Germany
| | - Andreas Mügge
- University Hospital St. Josef-Hospital Bochum, Cardiology and Rhythmology, Ruhr-University Bochum, Bochum, Germany
| | - Michael Gotzmann
- University Hospital St. Josef-Hospital Bochum, Cardiology and Rhythmology, Ruhr-University Bochum, Bochum, Germany,*Correspondence: Michael Gotzmann,
| |
Collapse
|
7
|
Orlov OS, Asfour A, Bogdanova AA, Shchekochikhin DY, Akselrod AS, Nesterov AP, Andreev DA. Predictors of tachycardia-induced cardiomyopathy in patients with first-time decompensation of chronic heart failure with reduced left ventricular ejection fraction of nonischemic etiology and persistent atrial tachyarrhythmia. KARDIOLOGIIA 2022; 62:56-62. [DOI: 10.18087/cardio.2022.11.n2262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/06/2022] [Accepted: 09/16/2022] [Indexed: 12/23/2022]
Abstract
Aim To identify possible predictors of tachycardia-induced cardiomyopathy (TICMP) in patients with newly developed decompensated chronic heart failure (CHF) of nonischemic origin with reduced left ventricular ejection fraction (LV EF) and with persistent atrial tachyarrhythmias. Material and methods This study included 88 patients with newly developed decompensated CHF of nonischemic origin with reduced LV EF and persistent atrial tachyarrhythmias. Resting 12-lead electrocardiography (EGC) and transthoracic echocardiography (EchoCG) were performed upon admission and following the electrical impulse therapy for all patients. Also, 24-h ECG monitoring was performed to confirm sinus rhythm stability. After recovery of sinus rhythm, outpatient monitoring was performed for three months, including repeated EchoCG to evaluate the dynamics of heart chamber dimensions and LV EF. Results The patients were divided into two groups based on the increase in LV EF: 68 responders (TICMP patients with a LV EF increase by >10%) and 20 non-responders (patients with an increase in LV EF by <10% during 3 months following the sinus rhythm recovery). According to results of the baseline EchoCG, LV EF did not significantly differ in the two subgroups (TICMP, 40±8.3 %, 18–50 % and non-responders, 38.55±7.9 %, 24–50 %); moreover, the incidence of cases with LV EF <30% did not differ either (9 patients TICMP and 2 non-responders, р=1.0). TICMP patients compared to non-responders, had significantly smaller left atrial dimensions (4.53±1.14 (2–7) cm and 5.68±1.41 (4–8) cm, р=0.034; 80.8±28.9 (27–215) ml and 117.8±41.3 (46–230) ml, р=0.03, respectively) and left ventricular end-systolic volume (ESV) (67.7±33.1 (29–140) ml and 104.5±44.7 (26–172) ml, р=0.02, respectively). The effect of major EchoCG parameters on the probability of TICMP development was assessed by one-factor and multifactor regression analyses with adjustments for age and sex. The probability of TICMP increased with the following baseline EchoCG parameters: end-diastolic volume (EDV) <174 ml [odd ratio (OR), 0.115, 95 % confidence interval (CI): 0.035–0.371], ESV <127 ml [OR, 0.034, 95 % CI: 0.007–0.181], left atrial volume <96 ml [OR, 0.08 , 95 % CI: 0.023–0.274], right ventricular dimension <4 cm [OR, 0.042 , 95 % CI: 0.005–0.389].Conclusion Among patients with newly developed decompensation of CHF with reduced LV EF of non-ischemic origin and persistent atrial arrhythmias, TICMP was detected in 72 % of patients. The probability of TICMP did not depend on baseline EF and duration of arrhythmias, but increased with the following baseline EchoCG parameters: EDV< 174 ml, ESV< 127 ml, left atrial volume <96 ml, right ventricular dimension <4 cm. The multifactorial analysis showed that a right atrial volume <96 ml is an independent predictor for the development of TICMP.
Collapse
Affiliation(s)
- O. S. Orlov
- Sechenov First Moscow State Medical University
| | - A. Asfour
- Sechenov First Moscow State Medical University
| | | | | | | | | | | |
Collapse
|
8
|
Vera A, Cecconi A, Martínez-Vives P, Olivera MJ, Hernández S, López-Melgar B, Rojas-González A, Díez-Villanueva P, Salamanca J, Tejelo J, Caballero P, Jiménez-Borreguero LJ, Alfonso F. Electrocardiogram and CMR to differentiate tachycardia-induced cardiomyopathy from dilated cardiomyopathy in patients admitted for heart failure. Heart Vessels 2022; 37:1850-1858. [PMID: 35657427 DOI: 10.1007/s00380-022-02102-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 05/11/2022] [Indexed: 12/23/2022]
Abstract
In patients admitted for heart failure (HF) with reduced left ventricular ejection fraction (LVEF) and a concomitant supraventricular tachyarrhythmia (SVT) it is a challenge to predict LVEF recovery and differentiate tachycardia-induced cardiomyopathy (TIC) from dilated cardiomyopathy (DCM). The role of the electrocardiogram (ECG) and cardiac magnetic resonance (CMR) and in this acute setting remains unsettled. Forty-three consecutive patients admitted for HF due to SVT and LVEF < 50% undergoing CMR in the acute phase, were retrospectively included. Those who had LVEF > 50% at follow up were classified as TIC and those with LVEF < 50% were classified as DCM. Clinical, CMR and ECG findings were analyzed to predict LVEF recovery. Twenty-five (58%) patients were classified as TIC. Patients with DCM had wider QRS (121.2 ± 26 vs 97.7 ± 17.35 ms; p = 0.003). On CRM the TIC group presented with higher LVEF (33.4 ± 11 vs 26.9 ± 6.4%; p = 0.019) whereas late gadolinium enhancement (LGE) was more frequent in DCM group (61 vs 16%; p = 0.004). On multivariate analysis, QRS duration ≥ 100 ms (p = 0.027), LVEF < 40% on CMR (p = 0.047) and presence of LGE (p = 0.03) were independent predictors of lack of LVEF recovery. Furthermore, during follow-up (median 60 months) DCM patients were admitted more frequently for HF (44 vs 0%; p < 0.001) than TIC patients. In patients with reduced LVEF admitted for HF due to SVT, QRS ≥ 100 ms, LVEF < 40% and LGE are independently associated with lack of LVEF recovery and worse clinical outcome.
Collapse
Affiliation(s)
- Alberto Vera
- Cardiology Department, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, IIS-IP, CIBER-CV, c/Diego de León 62, 28006, Madrid, Spain
| | - Alberto Cecconi
- Cardiology Department, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, IIS-IP, CIBER-CV, c/Diego de León 62, 28006, Madrid, Spain
| | - Pablo Martínez-Vives
- Cardiology Department, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, IIS-IP, CIBER-CV, c/Diego de León 62, 28006, Madrid, Spain
| | - María José Olivera
- Radiology Department, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, IIS-IP, Madrid, Spain
| | - Susana Hernández
- Radiology Department, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, IIS-IP, Madrid, Spain
| | - Beatriz López-Melgar
- Cardiology Department, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, IIS-IP, CIBER-CV, c/Diego de León 62, 28006, Madrid, Spain
| | - Antonio Rojas-González
- Cardiology Department, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, IIS-IP, CIBER-CV, c/Diego de León 62, 28006, Madrid, Spain
| | - Pablo Díez-Villanueva
- Cardiology Department, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, IIS-IP, CIBER-CV, c/Diego de León 62, 28006, Madrid, Spain
| | - Jorge Salamanca
- Cardiology Department, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, IIS-IP, CIBER-CV, c/Diego de León 62, 28006, Madrid, Spain
| | - Julio Tejelo
- Radiology Department, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, IIS-IP, Madrid, Spain
| | - Paloma Caballero
- Radiology Department, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, IIS-IP, Madrid, Spain
| | - Luis Jesús Jiménez-Borreguero
- Cardiology Department, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, IIS-IP, CIBER-CV, c/Diego de León 62, 28006, Madrid, Spain.
| | - Fernando Alfonso
- Cardiology Department, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, IIS-IP, CIBER-CV, c/Diego de León 62, 28006, Madrid, Spain
| |
Collapse
|
9
|
Purwowiyoto SL, Kusharsamita H. Arrhythmia-induced Cardiomyopathy: An Article Review. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Arrhythmia is one of the significant reversible causes in patients with heart disease and left ventricular dysfunction. Tachycardia, atrial fibrillation, and premature ventricular contractions have indeed been related to arrhythmia-induced cardiomyopathy (CM), a reversible dilated CM. Effective arrhythmia suppression will entirely or partially recover ventricular function, lowering morbidity and mortality. However, the importance of arrhythmia-induced CM (ARiCM) is often underestimated in clinical practice because arrhythmia is often seen as a result rather than a cause of CM, leading in treatment delays and failure to increase the quality of life and better clinical outcomes. This article review aims to summarize the pathomechanisms, and a general approach to the management of ARiCM and its long-term outcomes. ARiCM can cause a variety of clinical signs, ranging from asymptomatic to severe heart failure symptoms. Electrocardiogram, 24 h Holter monitoring, echocardiography, and cardiac magnetic resonance are all recommended for diagnosis. More research is required to better understand the pathogenesis of ARiCM and to differentiate treatment alternatives to choose the ideal ARiCM management approach.
Collapse
|
10
|
The C-terminal HCN4 variant P883R alters channel properties and acts as genetic modifier of atrial fibrillation and structural heart disease. Biochem Biophys Res Commun 2019; 519:141-147. [DOI: 10.1016/j.bbrc.2019.08.150] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 08/26/2019] [Indexed: 12/18/2022]
|
11
|
Sossalla S, Vollmann D. Arrhythmia-Induced Cardiomyopathy. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 115:335-341. [PMID: 29875055 DOI: 10.3238/arztebl.2018.0335] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 10/01/2017] [Accepted: 02/22/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Heart failure affects 1–2% of the population and is associated with elevated morbidity and mortality. Cardiac arrhythmias are often a result of heart failure, but they can cause left-ventricular systolic dysfunction (LVSD) as an arrhythmia-induced cardiomyopathy (AIC). This causal relationship should be borne in mind by the physician treating a patient with systolic heart failure in association with cardiac arrhythmia. METHODS This review is based on pertinent publications retrieved by a selective search in PubMed (1987–2017) and on the recommendations in current guidelines. RESULTS The key criterion for the diagnosis of an AIC is the demonstration of a persistent arrhythmia (including pathological tachycardia) together with an LVSD whose origin cannot be explained on any other basis. Nearly any type of tachyarrhythmia or frequent ventricular extrasystoles can lead, if persistent, to a progressively severe LVSD. The underlying pathophysiologic mechanisms are incompletely understood; the increased ventricular rate, asynchronous cardiac contractions, and neurohumoral activation all seem to play a role. The most common precipitating factors are supraventricular tachycardias in children and atrial fibrillation in adults. Recent studies have shown that the causal significance of atrial fibrillation in otherwise unexplained LVSD is underappreciated. The treatment of AIC consists primarily of the treatment of the underlying arrhythmia, generally with drugs such as beta-blockers and amiodarone. Depending on the type of arrhythmia, catheter ablation for long-term treatment should also be considered where appropriate. The diagnosis of AIC is considered to be well established when the LVSD normalizes or improves within a few weeks or months of the start of targeted treatment of the arrhythmia. CONCLUSION An AIC is potentially reversible. The timely recognition of this condition and the appropriate treatment of the underlying arrhythmia can substantially improve patient outcomes.
Collapse
Affiliation(s)
- Samuel Sossalla
- Department of Internal Medicine II, Cardiology, Pneumology, Intensive Care, University Hospital Regensburg
| | | |
Collapse
|
12
|
Nakano Y, Ochi H, Sairaku A, Onohara Y, Tokuyama T, Motoda C, Matsumura H, Tomomori S, Amioka M, Hironobe N, Ohkubo Y, Okamura S, Makita N, Yoshida Y, Chayama K, Kihara Y. HCN4 Gene Polymorphisms Are Associated With Occurrence of Tachycardia-Induced Cardiomyopathy in Patients With Atrial Fibrillation. CIRCULATION-GENOMIC AND PRECISION MEDICINE 2019; 11:e001980. [PMID: 29987112 DOI: 10.1161/circgen.117.001980] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 06/08/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Tachycardia-induced cardiomyopathy (TIC) is a reversible cardiomyopathy induced by tachyarrhythmia, and the genetic background of the TIC is not well understood. The hyperpolarization-activated cyclic nucleotide-gated channel gene HCN4 is highly expressed in the conduction system where it is involved in heart rate control. We speculated that the HCN4 gene is associated with TIC. METHODS We enrolled 930 Japanese patients with atrial fibrillation (AF) for screening, 350 Japanese patients with AF for replication, and 1635 non-AF controls. In the screening AF set, we compared HCN4 single-nucleotide polymorphism genotypes between AF subjects with TIC (TIC, n=73) and without TIC (non-TIC, n=857). Of 17 HCN4 gene-tag single-nucleotide polymorphisms, rs7172796, rs2680344, rs7164883, rs11631816, and rs12905211 were significantly associated with TIC. Among them, only rs7164883 was independently associated with TIC after conditional analysis (TIC versus non-TIC: minor allele frequency, 26.0% versus 9.7%; P=1.62×10-9; odds ratio=3.2). RESULTS We confirmed this association of HCN4 single-nucleotide polymorphism rs7164883 with TIC in the replication set (TIC=41 and non-TIC=309; minor allele frequency, 28% versus 9.9%; P=1.94×10-6; odds ratio=3.6). The minor allele frequency of rs7164883 was similar in patients with AF and non-AF controls (11% versus 10.9%; P=0.908). CONCLUSIONS The HCN4 gene single-nucleotide polymorphism rs7164883 may be a new genetic marker for TIC in patients with AF.
Collapse
Affiliation(s)
- Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan (Y.N., A.S., Y.O., T.T., C.M., H.M., S.T., M.A., N.H., S.O., Y.K.). .,Laboratory for Digestive Diseases, RIKEN Center for Integrative Medical Sciences, Hiroshima, Japan (Y.N., H.O., K.C.)
| | - Hidenori Ochi
- Laboratory for Digestive Diseases, RIKEN Center for Integrative Medical Sciences, Hiroshima, Japan (Y.N., H.O., K.C.).,Liver Research Project Center Hiroshima University, Hiroshima, Japan (H.O., K.C.).,Department of Internal Medicine, Chuden Hospital, The Chugoku Electric Power Company, Japan (H.O.).,Department of Gastroenterology and Metabolism, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan (H.O., K.C.)
| | - Akinori Sairaku
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan (Y.N., A.S., Y.O., T.T., C.M., H.M., S.T., M.A., N.H., S.O., Y.K.)
| | - Yuko Onohara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan (Y.N., A.S., Y.O., T.T., C.M., H.M., S.T., M.A., N.H., S.O., Y.K.)
| | - Takehito Tokuyama
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan (Y.N., A.S., Y.O., T.T., C.M., H.M., S.T., M.A., N.H., S.O., Y.K.)
| | - Chikaaki Motoda
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan (Y.N., A.S., Y.O., T.T., C.M., H.M., S.T., M.A., N.H., S.O., Y.K.)
| | - Hiroya Matsumura
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan (Y.N., A.S., Y.O., T.T., C.M., H.M., S.T., M.A., N.H., S.O., Y.K.)
| | - Shunsuke Tomomori
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan (Y.N., A.S., Y.O., T.T., C.M., H.M., S.T., M.A., N.H., S.O., Y.K.)
| | - Michitaka Amioka
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan (Y.N., A.S., Y.O., T.T., C.M., H.M., S.T., M.A., N.H., S.O., Y.K.)
| | - Naoya Hironobe
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan (Y.N., A.S., Y.O., T.T., C.M., H.M., S.T., M.A., N.H., S.O., Y.K.)
| | - Yousaku Ohkubo
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan (Y.N., A.S., Y.O., T.T., C.M., H.M., S.T., M.A., N.H., S.O., Y.K.)
| | - Shou Okamura
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan (Y.N., A.S., Y.O., T.T., C.M., H.M., S.T., M.A., N.H., S.O., Y.K.)
| | - Naomasa Makita
- Department of Molecular Physiology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan (N.M.)
| | - Yukihiko Yoshida
- Department of Cardiology, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan (Y.Y.)
| | - Kazuaki Chayama
- Laboratory for Digestive Diseases, RIKEN Center for Integrative Medical Sciences, Hiroshima, Japan (Y.N., H.O., K.C.).,Liver Research Project Center Hiroshima University, Hiroshima, Japan (H.O., K.C.).,Department of Gastroenterology and Metabolism, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan (H.O., K.C.)
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan (Y.N., A.S., Y.O., T.T., C.M., H.M., S.T., M.A., N.H., S.O., Y.K.)
| |
Collapse
|
13
|
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
|
14
|
Müller-Edenborn B, Minners J, Allgeier J, Burkhardt T, Lehrmann H, Ruile P, Merz S, Allgeier M, Neumann FJ, Arentz T, Jadidi A, Jander N. Rapid improvement in left ventricular function after sinus rhythm restoration in patients with idiopathic cardiomyopathy and atrial fibrillation. Europace 2019; 21:871-878. [DOI: 10.1093/europace/euz013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 01/31/2019] [Indexed: 12/19/2022] Open
Affiliation(s)
- Björn Müller-Edenborn
- Department of Cardiology, University Heart Center Freiburg—Bad Krozingen, Südring 15, Bad Krozingen, Germany
- Department of Electropyhsiology, University Heart Center Freiburg—Bad Krozingen, Südring 15, Bad Krozingen, Germany
| | - Jan Minners
- Department of Cardiology, University Heart Center Freiburg—Bad Krozingen, Südring 15, Bad Krozingen, Germany
| | - Jürgen Allgeier
- Department of Cardiology, University Heart Center Freiburg—Bad Krozingen, Südring 15, Bad Krozingen, Germany
- Department of Electropyhsiology, University Heart Center Freiburg—Bad Krozingen, Südring 15, Bad Krozingen, Germany
| | - Thilo Burkhardt
- Department of Cardiology, University Hospital, Basel, Switzerland
| | - Heiko Lehrmann
- Department of Cardiology, University Heart Center Freiburg—Bad Krozingen, Südring 15, Bad Krozingen, Germany
- Department of Electropyhsiology, University Heart Center Freiburg—Bad Krozingen, Südring 15, Bad Krozingen, Germany
| | - Philipp Ruile
- Department of Cardiology, University Heart Center Freiburg—Bad Krozingen, Südring 15, Bad Krozingen, Germany
| | - Sebastian Merz
- Department of Cardiology, University Heart Center Freiburg—Bad Krozingen, Südring 15, Bad Krozingen, Germany
| | - Martin Allgeier
- Department of Cardiology, University Heart Center Freiburg—Bad Krozingen, Südring 15, Bad Krozingen, Germany
| | - Franz-Josef Neumann
- Department of Cardiology, University Heart Center Freiburg—Bad Krozingen, Südring 15, Bad Krozingen, Germany
| | - Thomas Arentz
- Department of Cardiology, University Heart Center Freiburg—Bad Krozingen, Südring 15, Bad Krozingen, Germany
- Department of Electropyhsiology, University Heart Center Freiburg—Bad Krozingen, Südring 15, Bad Krozingen, Germany
| | - Amir Jadidi
- Department of Cardiology, University Heart Center Freiburg—Bad Krozingen, Südring 15, Bad Krozingen, Germany
- Department of Electropyhsiology, University Heart Center Freiburg—Bad Krozingen, Südring 15, Bad Krozingen, Germany
| | - Nikolaus Jander
- Department of Cardiology, University Heart Center Freiburg—Bad Krozingen, Südring 15, Bad Krozingen, Germany
| |
Collapse
|
15
|
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
|
16
|
Denham NC, Pearman CM, Caldwell JL, Madders GWP, Eisner DA, Trafford AW, Dibb KM. Calcium in the Pathophysiology of Atrial Fibrillation and Heart Failure. Front Physiol 2018; 9:1380. [PMID: 30337881 PMCID: PMC6180171 DOI: 10.3389/fphys.2018.01380] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 09/11/2018] [Indexed: 12/20/2022] Open
Abstract
Atrial fibrillation (AF) is commonly associated with heart failure. A bidirectional relationship exists between the two-AF exacerbates heart failure causing a significant increase in heart failure symptoms, admissions to hospital and cardiovascular death, while pathological remodeling of the atria as a result of heart failure increases the risk of AF. A comprehensive understanding of the pathophysiology of AF is essential if we are to break this vicious circle. In this review, the latest evidence will be presented showing a fundamental role for calcium in both the induction and maintenance of AF. After outlining atrial electrophysiology and calcium handling, the role of calcium-dependent afterdepolarizations and atrial repolarization alternans in triggering AF will be considered. The atrial response to rapid stimulation will be discussed, including the short-term protection from calcium overload in the form of calcium signaling silencing and the eventual progression to diastolic calcium leak causing afterdepolarizations and the development of an electrical substrate that perpetuates AF. The role of calcium in the bidirectional relationship between heart failure and AF will then be covered. The effects of heart failure on atrial calcium handling that promote AF will be reviewed, including effects on both atrial myocytes and the pulmonary veins, before the aspects of AF which exacerbate heart failure are discussed. Finally, the limitations of human and animal studies will be explored allowing contextualization of what are sometimes discordant results.
Collapse
Affiliation(s)
- Nathan C. Denham
- Unit of Cardiac Physiology, Division of Cardiovascular Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | | | | | | | | | | | - Katharine M. Dibb
- Unit of Cardiac Physiology, Division of Cardiovascular Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| |
Collapse
|
17
|
Tsai CT. HCN4 Gene Polymorphisms and Tachycardia-Induced Cardiomyopathy. Circ Genom Precis Med 2018; 11:e002223. [DOI: 10.1161/circgen.118.002223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Chia-Ti Tsai
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei
| |
Collapse
|
18
|
Yu HT, Yang PS, Lee H, You SC, Kim TH, Uhm JS, Kim JY, Pak HN, Lee MH, Joung B. Outcomes of Rate-Control Treatment in Patients With Atrial Fibrillation and Heart Failure - A Nationwide Cohort Study. Circ J 2017; 82:652-658. [PMID: 29142156 DOI: 10.1253/circj.cj-17-0669] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Rate control is now a front-line therapy in the management of atrial fibrillation (AF). However, the survival benefits of different rate-control medications remain controversial, so we assessed the efficacy of rate-control medications in AF patients with concomitant heart failure (HF).Methods and Results:From January 2002 to December 2008, a total of 7,034 AF patients with a single type of rate-control drug or without rate-control treatment were enrolled from the Korea National Health Insurance Service database. The death rates over a mean follow-up of 4.5±1.2 years were 12.6% (580 of 4,593) and 29.0% (709 of 2,441) in non-HF and HF patients, respectively. Among the total subjects, the risk of death was lower in patients receiving β-blockers (adjusted hazard ratio (HR) 0.75, 95% confidence interval (CI) 0.64-0.88) and calcium-channel blockers (adjusted HR 0.74, 95% CI 0.55-0.98) compared with those who did not receive rate-control medications. In patients without HF, use of rate-control medications did not affect the risk of death. In patients with HF, β-blockers significantly decreased the mortality risk (adjusted HR 0.63, 95% CI 0.50-0.79), whereas use of calcium-channel blockers or digoxin was not associated with death. The results were observed consistently among the cohorts after propensity matching. CONCLUSIONS Use of β-blockers was associated with a reduced mortality rate for AF patient with HF but not for those without HF. These findings should be examined in a large randomized trial.
Collapse
Affiliation(s)
- Hee Tae Yu
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
| | - Pil-Sung Yang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
| | - Hancheol Lee
- Division of Cardiology, National Health Insurance Service Ilsan Hospital
| | - Seng Chan You
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
| | - Tae-Hoon Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
| | - Jae-Sun Uhm
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
| | - Jong-Youn Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
| | - Hui-Nam Pak
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
| | - Moon-Hyoung Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
| | - Boyoung Joung
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
| |
Collapse
|
19
|
Affiliation(s)
- Claire A Martin
- Department of Cardiology, Barts Health NHS Trust, London, UK
| | - Pier D Lambiase
- Department of Cardiology, Barts Health NHS Trust, London, UK
| |
Collapse
|
20
|
Extracorporeal CPR and intra-aortic balloon pumping in tachycardia-induced cardiomyopathy complicating cardiac arrest. Am J Emerg Med 2017; 35:1208.e5-1208.e7. [DOI: 10.1016/j.ajem.2017.03.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 03/03/2017] [Accepted: 03/21/2017] [Indexed: 11/21/2022] Open
|
21
|
Recovery of renal dysfunction after catheter ablation of outflow tract ventricular arrhythmias in patients with ventricular premature depolarization-mediated cardiomyopathy. J Interv Card Electrophysiol 2016; 48:43-50. [DOI: 10.1007/s10840-016-0190-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 09/16/2016] [Indexed: 11/25/2022]
|
22
|
Kamada K, Kubo T, Sada M, Ishikita A, Tezuka M, Akiyama Y, Umezu R, Ogawa K, Horimoto K, Matsusaka H. Successful recovery of tachycardia-induced cardiomyopathy with severely depressed left ventricular systolic function by catheter ablation with mechanical hemodynamic support: a case report. Clin Case Rep 2016; 4:232-5. [PMID: 27014440 PMCID: PMC4771860 DOI: 10.1002/ccr3.482] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 12/09/2015] [Accepted: 12/12/2015] [Indexed: 11/09/2022] Open
Abstract
We describe the case that persistent atrial fibrillation refractory to rhythm control by pharmacotherapy and electrical cardioversions caused tachycardia‐induced cardiomyopathy with low ejection fraction and hemodynamic instability. Mechanical hemodynamic support using an intra‐aortic balloon pump is one of the choices of hemodynamic support during catheter ablation by pulmonary vein isolation.
Collapse
Affiliation(s)
- Kazuhiro Kamada
- Department of Cardiology Matsuyama Red Cross Hospital Matsuyama Ehime Japan
| | - Toshihiko Kubo
- Department of Cardiology Matsuyama Red Cross Hospital Matsuyama Ehime Japan
| | - Masashi Sada
- Department of Cardiology Matsuyama Red Cross Hospital Matsuyama Ehime Japan
| | - Akihito Ishikita
- Department of Cardiology Matsuyama Red Cross Hospital Matsuyama Ehime Japan
| | - Mika Tezuka
- Department of Cardiology Matsuyama Red Cross Hospital Matsuyama Ehime Japan
| | - Yusuke Akiyama
- Department of Cardiology Matsuyama Red Cross Hospital Matsuyama Ehime Japan
| | - Ryuta Umezu
- Department of Cardiology Matsuyama Red Cross Hospital Matsuyama Ehime Japan
| | - Kiyohiro Ogawa
- Department of Cardiology Matsuyama Red Cross Hospital Matsuyama Ehime Japan
| | - Koshin Horimoto
- Department of Cardiology Matsuyama Red Cross Hospital Matsuyama Ehime Japan
| | - Hidenori Matsusaka
- Department of Cardiology Matsuyama Red Cross Hospital Matsuyama Ehime Japan
| |
Collapse
|
23
|
Novel perspectives on arrhythmia-induced cardiomyopathy: pathophysiology, clinical manifestations and an update on invasive management strategies. Cardiol Rev 2016; 23:135-41. [PMID: 25133468 DOI: 10.1097/crd.0000000000000040] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Arrhythmia-induced cardiomyopathy is a partially or completely reversible form of myocardial dysfunction due to sustained supraventricular and ventricular arrhythmias. Asynchrony, rapid cardiac rates and rhythm irregularities are the main factors involved in the development of the disease. The reversible nature of arrhythmia-induced cardiac dysfunction allows only for a retrospective diagnosis of the disease once cardiac function is restored following heart rate control. A high level of suspicion is needed to make a diagnosis at an early stage and prevent further progression of the disease. Although reversible, arrhythmia-induced cellular and molecular changes may remain, increasing the risk for sudden death even when normal ejection fraction is restored as well as causing rapid deterioration of cardiac function and development of heart failure symptoms if arrhythmia recurs. Appropriate management based on a combination of pharmacologic and nonpharmacologic strategies to achieve rate control and prevent arrhythmia recurrence is pivotal to avoid further cardiac function deterioration and to control symptoms, significantly reducing the risk of heart failure and sudden cardiac death.
Collapse
|
24
|
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
| |
Collapse
|
25
|
Siontis KC, Geske JB, Gersh BJ. Atrial fibrillation pathophysiology and prognosis: insights from cardiovascular imaging. Circ Cardiovasc Imaging 2015; 8:CIRCIMAGING.115.003020. [PMID: 26022381 DOI: 10.1161/circimaging.115.003020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Konstantinos C Siontis
- From Department of Medicine (K.C.S.), Division of Cardiovascular Diseases (J.B.G., B.J.G.), Mayo Clinic College of Medicine, Rochester, MN
| | - Jeffrey B Geske
- From Department of Medicine (K.C.S.), Division of Cardiovascular Diseases (J.B.G., B.J.G.), Mayo Clinic College of Medicine, Rochester, MN
| | - Bernard J Gersh
- From Department of Medicine (K.C.S.), Division of Cardiovascular Diseases (J.B.G., B.J.G.), Mayo Clinic College of Medicine, Rochester, MN.
| |
Collapse
|
26
|
Nakayama M, Fuse K, Sato M, Okabe M, Komatsu Y, Yamashina A, Aizawa Y. Cardiogenic shock induced by bisoprolol in a patient with CYP2D6 variant. A case report. J Cardiol Cases 2015; 11:109-112. [DOI: 10.1016/j.jccase.2014.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 12/09/2014] [Accepted: 12/17/2014] [Indexed: 10/24/2022] Open
|
27
|
Seitz J, Beurtheret S. Letter by Seitz and Beurtheret regarding article, "Causes of death and influencing factors in patients with atrial fibrillation: a competing risk analysis from the randomized evaluation of long-term anticoagulant therapy study". Circulation 2014; 130:e84. [PMID: 25156922 DOI: 10.1161/circulationaha.113.007001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Julien Seitz
- Electrophysiology Unit of Saint Joseph Hospital Marseille, France
| | | |
Collapse
|
28
|
Suzuki A, Shiga T, Arai K, Shoda M. Reversible cardiomyopathy after radiofrequency ablation of 30-year persistent atrial tachycardia. BMJ Case Rep 2013; 2013:bcr-2013-008727. [PMID: 24326427 DOI: 10.1136/bcr-2013-008727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Tachycardia-induced cardiomyopathy (TIC) is a reversible form of the left ventricular (LV) systolic dysfunction and is believed to be a relatively acute process. We report a TIC case with a 30-year history of long-lasting persistent atrial tachycardia involving a 44-year-old man previously diagnosed with dilated cardiomyopathy and a low LV ejection fraction (LVEF) of 20%. ECG revealed atrial tachycardia at 110-120 bpm. He was hospitalised with a worsening heart failure. His clinical status was New York Heart Association functional class III, and echocardiography revealed LV dilation and an LVEF of 9%. A two-dimensional speckle-tracking strain measurement revealed LV mechanical dyssynchrony. He underwent radiofrequency ablation for atrial tachycardia. After restoring sinus rhythm, his cardiac symptoms improved immediately. The LV mechanical dyssynchrony decreased a week after ablation, without changes in the LV dilation or LVEF. Thereafter, the LV dilation and systolic function gradually improved, and atrial tachycardia and heart failure remained absent.
Collapse
Affiliation(s)
- Atsushi Suzuki
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | | | | | | |
Collapse
|
29
|
Impact of radiofrequency catheter ablation on echocardiographic and cardiopulmonary performance in patients with ventricular extrasystolic beats and suspected arrhythmia-induced cardiomyopathy. Heart Vessels 2013; 29:808-16. [DOI: 10.1007/s00380-013-0417-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 09/27/2013] [Indexed: 10/26/2022]
|
30
|
Maan A, Mansour M, N Ruskin J, Heist EK. Current Evidence and Recommendations for Rate Control in Atrial Fibrillation. Arrhythm Electrophysiol Rev 2013; 2:30-5. [PMID: 26835037 PMCID: PMC4711525 DOI: 10.15420/aer.2013.2.1.30] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 04/15/2013] [Indexed: 01/29/2023] Open
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia encountered in clinical practice, which is associated with substantial risk of stroke and thromboembolism. As an arrhythmia that is particularly common in the elderly, it is an important contributor towards morbidity and mortality. Ventricular rate control has been a preferred and therapeutically convenient treatment strategy for the management of AF. Recent research in the field of rhythm control has led to the advent of newer antiarrhythmic drugs and catheter ablation techniques as newer therapeutic options. Currently available antiarrhythmic drugs still remain limited by their suboptimal efficacy and significant adverse effects. Catheter ablation as a newer modality to achieve sinus rhythm (SR) continues to evolve, but data on long-term outcomes on its efficacy and mortality outcomes are not yet available. Despite these current developments, rate control continues to be the front-line treatment strategy, especially in older and minimally symptomatic patients who might not tolerate the antiarrhythmic drug treatment. This review article discusses the current evidence and recommendations for ventricular rate control in the management of AF. We also highlight the considerations for rhythm control strategy in the management of patients of AF.
Collapse
Affiliation(s)
| | | | | | - E Kevin Heist
- Assistant Professor of Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, US
| |
Collapse
|
31
|
Chin A, Badri M, Ntusi NB, Okreglicki A. The clinical, electrocardiographic and echocardiographic characteristics and long-term outcome of patients with tachycardia-induced cardiomyopathy. Cardiovasc J Afr 2013; 23:136-42. [PMID: 22555637 PMCID: PMC3721947 DOI: 10.5830/cvja-2011-019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2011] [Accepted: 05/09/2011] [Indexed: 11/23/2022] Open
Abstract
Introduction The clinical, electrocardiographic and echocardiographic features and long-term outcome of patients with tachycardia-induced cardiomyopathy (TIC) have not been well described in the past. Methods A retrospective study was performed at our institution of patients with a diagnosis of TIC. Results Thirty-three patients with pure TIC and 12 patients with impure TIC were identified. Compared to patients with dilated cardiomyopathy (DCMO), pure TIC patients were less symptomatic, as judged by NYHA class (p = 0.02), they had fewer clinical signs of heart failure (p = 0.007) and were more likely to report palpitations (p = 0.007) at presentation. Electrocardiographically, pure TIC patients had fewer Q waves (p = 0.002), less left ventricular hypertrophy (LVH) (p = 0.004) and repolarisation abnormalities (p = 0.048), and shorter QRS durations (p = 0.024). Echocardiographically, pure TIC patients had significantly smaller left ventricular internal diameter in diastole (LVIDd) (p < 0.001), ventricular internal diameter in systole (LVIDs) (p = 0.001) and left atrial dimensions (p = 0.048) at presentation compared to DCMO patients. Patients with pure TIC had a trend towards increased residual LVIDd dimensions compared to a control group with normal echocardiograms, indicating a persistence of adverse LV remodelling late after control of the causative tachycardia (p = 0.06). Recurrent tachycardia occurred in three patients, which resulted in a precipitous decline in left ventricular ejection fraction (LVEF). Conclusions This study is the first to compare features of pure and impure TIC. Patients with pure TIC had shorter QRS durations, fewer Q waves, and less LVH and repolarisation abnormalities at presentation compared to DCMO patients. TIC patients tended to have smaller LVIDd dimensions at presentation and have persistence of adverse LV remodelling, as characterised by persistent enlargement of LVIDd dimensions, at late follow up.
Collapse
Affiliation(s)
- Ashley Chin
- Cardiac Clinic, Groote Schuur Hospital, and Department of Medicine, University of Cape Town, Cape Town, South Africa.
| | | | | | | |
Collapse
|
32
|
Lee SY, Kim J, Lee SH, Choi JH, Park YH, Kim JH, Chun KJ. Ventricular Fibrillation in a Patient with Tachycardia-Induced Cardiomyopathy after Liver Transplantation. Korean Circ J 2013; 43:839-41. [PMID: 24385997 PMCID: PMC3875702 DOI: 10.4070/kcj.2013.43.12.839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 07/05/2013] [Accepted: 08/07/2013] [Indexed: 11/21/2022] Open
Abstract
We report a case of atrial fibrillation-related tachycardia induced cardiomyopathy and ventricular fibrillation after liver transplantation in a 41-year-old man with end-stage liver failure. Atrial fibrillation and congestive heart failure occurred postoperatively. Cardiac arrests due to ventricular fibrillation occurred 6 months after the operation with subsequent implantations of an implantable cardioverter-defibrillator. Ventricular arrhythmias did not recur during the 18 months after normalization of heart functions with guideline-directed medical treatments.
Collapse
Affiliation(s)
- Soo Yong Lee
- Department of Cardiology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jun Kim
- Department of Cardiology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Sang Hyun Lee
- Department of Cardiology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jin Hee Choi
- Department of Cardiology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Yong Hyun Park
- Department of Cardiology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - June Hong Kim
- Department of Cardiology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Kook Jin Chun
- Department of Cardiology, Pusan National University Yangsan Hospital, Yangsan, Korea
| |
Collapse
|
33
|
|
34
|
Abstract
Atrial fibrillation (AF) is the most common arrhythmia encountered by generalists and cardiologists alike. Much of the attendant morbidity from AF arises from systemic embolic complications which are effectively reduced with utilization of anti-platelet and/or anticoagulant therapy. The systemic embolic complications of AF and the medical therapy to attenuate these risks are very well established. Through the course of this review, we aim to highlight the complex relationship between AF and other, "non-embolic" outcomes. The presence of AF has been demonstrated to be associated with a 1.5 to 2-fold increase in mortality across numerous observational cohorts. Still further, AF frequently coexists with heart failure, whether as a causative factor or a consequence of underlying structural heart disease or neurohumoral derangement, where its presence is associated with worse clinical outcomes. Whether AF is an independent risk factor for acute coronary syndromes (ACS) remains controversial, though its occurrence in patients with ACS has been shown to be associated with adverse outcomes both in observational cohorts as well as clinical trial populations. Individuals with AF have a 1.5 to 3-fold increase in the rate of hospitalization and are at elevated risk for other arrhythmic disorders including both bradyarrhythmias as well as tachyarrhythmias. AF leads to considerable morbidity and mortality for patients and exacts a tremendous financial toll on the healthcare system-estimated to range from $6.0 to $26.0 billion. Given the current demographic transition in developed countries, the prevalence of AF will continue to increase and the need for refined approaches to risk stratification and pharmacotherapeutic interventions to attenuate the burden on patients will only become more important.
Collapse
Affiliation(s)
- Nihar R Desai
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | |
Collapse
|
35
|
Heist EK, Mansour M, Ruskin JN. Rate control in atrial fibrillation: targets, methods, resynchronization considerations. Circulation 2012; 124:2746-55. [PMID: 22155996 DOI: 10.1161/circulationaha.111.019919] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- E Kevin Heist
- Cardiac Arrhythmia Service and Heart Center, Massachusetts General Hospital, Boston, MA 02114, USA
| | | | | |
Collapse
|
36
|
Catheter ablation of long-lasting accelerated idioventricular rhythm in a patient with mild left ventricular dysfunction. Case Rep Cardiol 2012; 2012:143864. [PMID: 24826233 PMCID: PMC4008092 DOI: 10.1155/2012/143864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 07/12/2012] [Indexed: 12/04/2022] Open
Abstract
A 35-year-old woman with long-lasting accelerated idioventricular rhythm (AIVR) exhibited palpitation and dyspnea on exertion and mild left ventricular (LV) dysfunction during followup. Symptoms appeared 10 years after the AIVR was first noted, and she underwent catheter ablation for curative therapy of AIVR after 12 years. Radiofrequency ablation of the anteroseptal site of the LV at the earliest activation terminated rhythm. An echocardiogram, taken 1 month after discharge, subsequently revealed that the left ventricular wall motion had normalized. This is a rare case of long-lasting AIVR with mild LV dysfunction.
Collapse
|
37
|
Rubenstein JC, Roth JA. Atrioventricular junction ablation and pacemaker implantation for heart failure associated with atrial fibrillation: potential issues and therapies in the setting of acute heart failure syndrome. Heart Fail Rev 2011; 16:457-65. [PMID: 21424742 DOI: 10.1007/s10741-011-9238-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Atrial fibrillation is the most common arrhythmia and is especially clinically important in patients with heart failure. Prolonged atrial fibrillation with high ventricular rate response may lead to development or worsening of left ventricular function. If adequate heart rate control cannot be obtained medically, often patients will undergo pacemaker implant and catheter ablation of the atrioventricular junction. This intervention can have profound effects on the course of heart failure. This article reviews the technique, complications, outcome data, and alternatives to this management strategy. The potential role of this therapeutic modality in those hospitalized with acute heart failure syndromes is discussed.
Collapse
Affiliation(s)
- Jason C Rubenstein
- Department of Medicine, Division of Cardiovascular Medicine, Froedtert East Clinics, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA.
| | | |
Collapse
|
38
|
Simantirakis EN, Koutalas EP, Vardas PE. Arrhythmia-induced cardiomyopathies: the riddle of the chicken and the egg still unanswered? Europace 2011; 14:466-73. [DOI: 10.1093/europace/eur348] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
|
39
|
Safaei N, Montazerghaem H, Azarfarin R, Alizadehasl A, Alikhah H. Radiofrequency ablation for treatment of atrial fibrillation. BIOIMPACTS : BI 2011; 1:171-7. [PMID: 23678423 DOI: 10.5681/bi.2011.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Revised: 07/28/2011] [Accepted: 08/15/2011] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Atrial Fibrillation (AF) is the most common cardiac arrhythmia which represents a major public health problem. The main purpose of this research is to evaluate the Radiofrequency (RF) ablation effects in the patients with chronic AF scheduled for cardiac surgery because of different heart diseases. METHODS The descriptive and prospective study was conducted on 60 patients with AF scheduled for surgery along with RF ablation. The data were collected by questionnaire and included: patients' age, sex, NYHA class, operation type, past medical history, type and cause of valvular heart disease, preoperative ECG (electrocardiogram), duration of surgery, clamping time, cardiopulmonary bypass, and RF ablation time. RF ablation was followed by the main operation. The follow up examination, ECG, and echocardiography were performed 3 and 6 months after operation. RESULTS The mean age of patients was 48±10 years (18-71 years). Forty one patients had permanent AF and 19 had the persistent AF. The left ventricular ejection fraction was 48.27±9.75 percent before operation, and reached to 56.27±7.87 percent after the surgery (P<0.001). The mean NYHA class before the surgery was 2.83±0.68 which decreased to 1.34±0.46 6 months after the surgery with RF ablation (P<0.001). One patient (1.6%) died after surgery. Complete relief and freedom from AF recurrence was observed in 70% of patients in the mean follow up in 7 months after the surgery. The sinus rhythm with efficient atrial contraction was established in 100% of discharged patients. CONCLUSION RF ablation is an effective procedure to cure atrial fibrillation in patients undergoing cardiac surgeries.
Collapse
Affiliation(s)
- Nasser Safaei
- Department of Cardiothoracic Surgery, Shahid Madani Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | | | | | | |
Collapse
|
40
|
Lishmanov A, Chockalingam P, Senthilkumar A, Chockalingam A. Tachycardia-induced cardiomyopathy: evaluation and therapeutic options. ACTA ACUST UNITED AC 2011; 16:122-6. [PMID: 20557332 DOI: 10.1111/j.1751-7133.2010.00147.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Tachycardia-induced cardiomyopathy is caused by sustained rapid ventricular rates and is one of the well-known forms of reversible myocardial dysfunction. The diagnosis is usually made retrospectively after marked improvement in systolic function is noted following control of the heart rate. Physicians should be aware that patients with seemingly idiopathic systolic dysfunction may have tachycardia-induced cardiomyopathy and that controlling the heart rate may result in improvement or even complete restoration of systolic function.
Collapse
Affiliation(s)
- Anton Lishmanov
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Missouri School of Medicine, Columbia, MO 65212, USA
| | | | | | | |
Collapse
|
41
|
Shin SY, Lim HE, Choi UJ, Choi CU, Kim SH, Kim JW, Kim EJ, Rha SW, Park CG, Seo HS, Oh DJ, Shin C, Kim YH. Impaired Transport Function of the Left Atrium in Patients with Lone Paroxysmal Atrial Fibrillation. Echocardiography 2010; 28:44-51. [DOI: 10.1111/j.1540-8175.2010.01271.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
42
|
|
43
|
Suzuki S, Yamashita T, Ohtsuka T, Sagara K, Uejima T, Oikawa Y, Yajima J, Koike A, Nagashima K, Kirigaya H, Ogasawara K, Sawada H, Yamazaki T, Aizawa T. Body Size and Atrial Fibrillation in Japanese Outpatients. Circ J 2010; 74:66-70. [DOI: 10.1253/circj.cj-09-0431] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Shinya Suzuki
- Department of Clinical Epidemiology&Systems, Graduate School of Medicine, The University of Tokyo
| | | | | | | | | | | | | | | | | | | | | | | | - Tsutomu Yamazaki
- Department of Clinical Epidemiology&Systems, Graduate School of Medicine, The University of Tokyo
| | | |
Collapse
|
44
|
Neuberger HR, Reil JC, Adam O, Laufs U, Mewis C, Böhm M. Atrial fibrillation in heart failure: current treatment of patients with remodeled atria. Curr Heart Fail Rep 2009; 5:219-25. [PMID: 19032917 DOI: 10.1007/s11897-008-0033-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Atrial fibrillation (AF) and chronic heart failure (CHF) can be caused by each other, and therefore constitute a vicious circle. The prevalence of both conditions is about 1% in industrialized countries and increases with age. Although mortality is increased in heart failure, the additional prognostic relevance of AF in these patients is less clear. AF in patients with CHF can worsen heart failure symptoms, cause complications (eg, stroke), and is difficult to treat. Thus, prevention of AF entirely is an important goal. This review summarizes recent data concerning prognostic relevance, treatment, and means of primary and secondary prevention of AF in patients with CHF.
Collapse
Affiliation(s)
- Hans-Ruprecht Neuberger
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, D-66421, Homburg/Saar, Germany.
| | | | | | | | | | | |
Collapse
|
45
|
Aikawa M, Watanabe H, Shimokawa T, Inoue K, Takamisawa I, Seki A, Tobaru T, Iguchi N, Misu K, Nagayama M, Asano R, Umemura J, Takanashi S, Sumiyoshi T. Preoperative Left Atrial Emptying Fraction is a Powerful Predictor of Successful Maze Procedure. Circ J 2009; 73:269-73. [DOI: 10.1253/circj.cj-08-0281] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Masaru Aikawa
- Department of Cardiology, Sakakibara Heart Institute
| | | | - Tomoki Shimokawa
- Department of Cardiovascular Surgery, Sakakibara Heart Institute
| | - Kanki Inoue
- Department of Cardiology, Sakakibara Heart Institute
| | | | - Atsushi Seki
- Department of Cardiology, Sakakibara Heart Institute
| | | | - Nobuo Iguchi
- Department of Cardiology, Sakakibara Heart Institute
| | - Kazuhiko Misu
- Department of Cardiology, Sakakibara Heart Institute
| | | | - Ryuta Asano
- Department of Cardiology, Sakakibara Heart Institute
| | - Jun Umemura
- Department of Cardiology, Sakakibara Heart Institute
| | | | | |
Collapse
|
46
|
Ishibashi K, Osamura T, Yamahara Y. Myocardial stunning with partial aneurysmal formation generated during the recovering process of tachycardia-induced cardiomyopathy. J Cardiol 2008; 54:121-7. [PMID: 19632531 DOI: 10.1016/j.jjcc.2008.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Revised: 09/09/2008] [Accepted: 10/01/2008] [Indexed: 10/21/2022]
Abstract
We report a rare case of tachycardia-induced cardiomyopathy with apical stunning followed by partial aneurysmal formation. A 66-year-old male was admitted because of dyspnea and palpitation. Electrocardiogram showed persistent tachycardia due to atrial flutter. Echocardiography and left ventriculography showed severely diffuse hypokinesis with ejection fraction (EF) of 25%. Coronary arteries were normal. Heart failure responded well to conventional medical treatments. On day 9, persistent ST-segment elevation was disclosed before the ablation for atrial flutter. He was asymptomatic and free from the elevation of myocardial enzymes in laboratory data. (201)Tl scintigraphy showed slight hypoperfusion at a narrow site of the apex, whereas (123)I-betamethyl-iodophenyl-pentadecanoic acid scintigraphy revealed complete defect in the apical area. Left ventriculography showed akinesis at the localized site in the apex and mild hypokinesis in the basal area, with EF of 43%. However, no abnormalities were detected in coronary arteries during the ST-segment elevation. After 3 months, left ventriculography revealed the aneurysmal formation at a part of the apex, with EF of 50%, although the apical movement was improved. Moreover, coronary spasm was not induced by the intracoronary injection of ergonovine. In this case, a mechanism similar to Tako-Tsubo cardiomyopathy was speculated for the apical stunning.
Collapse
Affiliation(s)
- Kazuya Ishibashi
- Department of Cardiology, Saiseikai Kyoto Hospital, 8 Minamihirao, Imazato, Nagaoka-kyo, Kyoto 617-0814, Japan.
| | | | | |
Collapse
|
47
|
Dandamudi G, Rampurwala AY, Mahenthiran J, Miller JM, Das MK. Persistent left ventricular dilatation in tachycardia-induced cardiomyopathy patients after appropriate treatment and normalization of ejection fraction. Heart Rhythm 2008; 5:1111-4. [PMID: 18675220 DOI: 10.1016/j.hrthm.2008.04.023] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2007] [Accepted: 04/18/2008] [Indexed: 10/22/2022]
Abstract
BACKGROUND Tachycardia-induced cardiomyopathy (TIC) seems to be a form of reversible cardiomyopathy. With recurrence, TIC can be more severe and may increase the risk for sudden cardiac death. OBJECTIVE We postulate that negative remodeling persists even though ejection fraction (EF) normalizes after appropriate treatment in these patients. METHODS We analyzed 2-dimensional echocardiographic parameters of 24 patients with TIC (male: 21; age: 64.1 +/- 15.2 years; atrial arrhythmias: 92%) that improved significantly with treatment (mean time between pretreatment and posttreatment echocardiography: 14 +/- 6 months) and compared them with that of age-, gender-, and ejection fraction-matched control subjects without a history of TIC. RESULTS The majority of posttreatment echocardiographic parameters showed a significant improvement (P <.05) with treatment in patients with TIC, including left ventricular (LV) ejection fraction (31.2% +/- 8.2% to 55.0% +/- 5.7%) and LV end systolic volume index (55 +/- 21 ml/m(2) to 33 +/- 13 ml/m(2)). There was no significant difference in LV end diastolic volume index (78 +/- 22 ml/m(2) to 72 +/- 22 ml/m(2), P = .15). However, when compared with age-, gender-, and ejection fraction-matched control subjects, posttreatment echocardiographic parameters in TIC patients showed significant differences (TIC vs control group) in LV end systolic volume index (33 +/- 13 ml/m(2) vs 22 +/- 5 ml/m(2)), LV end diastolic volume index (72 +/- 22 ml/m(2) vs 51 +/- 12 ml/m(2)), and cardiac index (2.6 +/- 0.8 l/min/m(2) vs 1.8 +/- 0.6 l/min/m(2)). CONCLUSION Although the majority of echocardiographic parameters, including EF, improved significantly with treatment in TIC patients, LV dimensions and volumes remained significantly elevated when compared with control subjects, indicating persistence of negative LV remodeling, even after appropriate treatment and normalization of EF at a mean follow-up of 14 months.
Collapse
Affiliation(s)
- Gopi Dandamudi
- Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.
| | | | | | | | | |
Collapse
|