Successful Reversal of Severe Tachycardia-Induced Cardiomyopathy with Cardiogenic Shock by Urgent Rhythm or Rate Control: Only Rhythm and Rate Matter.

Kim Volle,Michel Galinier,Pierre Mondoly,Quentin Voglimacci-Stephanopoli,Clément Delmas,Hubert Delasnerie,Olivier Lairez,Yoan Lavie-Badie,Jerôme Roncalli,Caroline Biendel,Didier Carrié,Philippe Maury,Eve Cariou,Franck Mandel,Anne Rollin,Maxime Beneyto,Pauline Fournier

doi:10.3390/jcm10194504

Abstract

Background and objectives Severe forms of Tachycardia-induced cardiomyopathy (TIC) with cardiogenic shock are not well described so far, and efficiency of catheter ablation in this setting is unknown. Methods We retrospectively included consecutive patients admitted to the Intensive Cardiac Care Unit for acute heart failure with cardiogenic shock associated with atrial arrhythmia and managed by ablation. Result Fourteen patients were included, each with cardiogenic shock and two needing the use of extracorporeal membrane oxygenation. Successful ablation was performed in the acute setting or over the following weeks. Two patients experienced relapses of arrhythmias and were treated by new ablation procedures. At 7.5 ± 5 months follow-up, all patient were alive with stable sinus rhythm. The left ventricular Ejection Fraction dramatically improved (21 vs. 54%, p = 0.001) as well as the end-diastolic left ventricular diameter (61 vs. 51 mm, p = 0.01) and NYHA class (class IV in all vs. median 1, p = 0.002). Conclusion Restoration and maintenance of sinus rhythm in severe TIC with cardiogenic shock and atrial arrhythmias lead to a major increase or normalization of LVEF, reduction of ventricular dimensions, and improvement in functional status. Ablation is efficient in long-term maintenance of sinus rhythm and may be proposed early in refractory cases.

Highlights

Heart failure affects 1–2% of subjects in developed countries, concerning more than10% of people over the age of 70 [1], representing a leading cause of morbidity and mortality.Identifying a potentially reversible cause of heart failure and improving and eventually normalizing left ventricular systolic function is of major interest.Tachycardia-induced cardiomyopathy (TIC) is a well-known reversible cause of heart failure
During the same period of time, around 400 patients were admitted for cardiogenic shock at our institution, and around 60 were in AFib
All patients presented with supraventricular arrhythmia on ECG: atrial fibrillation (AF)

Summary

Introduction

Identifying a potentially reversible cause of heart failure and improving and eventually normalizing left ventricular systolic function is of major interest. Tachycardia-induced cardiomyopathy (TIC) is a well-known reversible cause of heart failure. TIC was described as early as 1949 by Philip and Levine, after observing that rapid atrial fibrillation (AF) can induce transient heart failure in patients with otherwise normal hearts [2]. TIC can be defined as a reversible left ventricular systolic alteration secondary to persisting or incessant rapid tachycardia [3,4,5]. Any arrhythmia sufficiently fast and prolonged can be responsible for TIC [4], but AF is the leading cause of TIC in adults [4]. With cardiogenic shock are not well described so far, and efficiency of catheter ablation in this setting is unknown

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Discussion

Conclusion