Successful reversal of Severe Tachycardia-Induced Cardiomyopathy with cardiogenic shock by ablation

Abstract

Tachycardia-induced cardiomyopathy (TIC) is a reversible cause of heart failure. Severe forms of TIC with low cardiac output and/or cardiogenic shock are not well described so far, and efficiency of catheter ablation in this setting is unknown. We retrospectively included consecutive patients admitted to the Intensive Cardiac Care Unit for acute heart failure with low cardiac output and or/cardiogenic shock associated with atrial arrhythmia and managed by ablation. 14 patients were included, each with cardiogenic shock and two needing the use of an extracorporeal membrane oxygenation. Successful ablation was performed in the acute setting or over the following weeks. Five patients experienced relapses of arrhythmias and were treated by new ablation procedures. At 7 ± 5 month's follow-up, all patients were alive with stable sinus rhythm. LVEF dramatically improved (22 ± 8% vs. 52 ± 6%, P < 0.0001) as well as LVEDD (61 ± 5 mm vs. 53 ± 5 mm, P = 0.003) and NYHA class (3.4 ± 0.7 vs. 1.4 ± 0.5, P < 0.0001). Catheter ablation for atrial arrhythmias in severe TIC with low cardiac output and/or cardiogenic shock is efficient and leads to major increase or normalization of LVEF, reduction of the ventricular dimensions and improvement in functional status. Ablation should be proposed very early in such cases.