Author + information
- Received November 1, 2018
- Revision received February 13, 2019
- Accepted February 18, 2019
- Published online May 6, 2019.
- Jose F. Huizar, MDa,b,∗ ( )(, )@VCUHealth,
- Kenneth A. Ellenbogen, MDa,
- Alex Y. Tan, MDa,b and
- Karoly Kaszala, MD, PhDa,b
- aVirginia Commonwealth University/Pauley Heart Center, Richmond, Virginia
- bHunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia
- ↵∗Address for correspondence:
Dr. Jose F. Huizar, Virginia Commonwealth University/Pauley Heart Center, Hunter Holmes McGuire VA Medical Center, 1201 Broad Rock Boulevard, Suite 4A-100, Richmond, Virginia 23249.
• Tachycardias, AF, and PVCs are known to trigger a reversible dilated CM.
• AiCM should be highly suspected in patients without an obvious etiology.
• Ambulatory ECG monitors are key to screen and properly diagnose AiCM.
• Reversal of CM by elimination of arrhythmia not only confirms the diagnosis but may significantly improve outcomes.
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.
- heart failure
- left ventricular dysfunction
- premature ventricular contractions
- supraventricular tachycardia
Dr. Huizar has received funding from the National Institutes of Health as a Principal Investigator (1R01HL139874-01 and 5R34HL138110-02). Dr. Ellenbogen has served as a consultant, on the Data Safety Monitoring Board, and as a lecturer for Medtronic and Boston Scientific; has performed talks for and received lecture fees from Biotronik; and has served as a consultant for and received lecture fees from Abbott and Biosense Webster. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received November 1, 2018.
- Revision received February 13, 2019.
- Accepted February 18, 2019.
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