Clinical Research
Heart Rhythm Disorder
Tachycardia-Mediated Cardiomyopathy Secondary to Focal Atrial Tachycardia: Long-Term Outcome After Catheter Ablation

https://doi.org/10.1016/j.jacc.2009.02.014Get rights and content
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Objectives

This study aimed to characterize the incidence, clinical and electrophysiologic features, and long-term outcomes of patients with tachycardia-mediated cardiomyopathy (TCM) secondary to focal atrial tachycardia (AT).

Background

TCM is known to complicate atrial tachyarrhythmias. Little is known of the patient and tachycardia characteristics associated with the development of left ventricular (LV) dysfunction and the long-term outcomes after cure of tachycardia.

Methods

A total of 345 patients with focal AT underwent radiofrequency ablation between January 1997 and July 2008. A retrospective analysis was performed to identify patients with LV dysfunction, defined as an ejection fraction <50% on echocardiography. Patients with pre-existing structural heart disease (n = 14) were excluded. Patients with TCM (n = 30) and without TCM (n = 301) were compared. Recovery of LV function was also assessed.

Results

The incidence of TCM was 10%. Incessant or very frequent paroxysmal tachycardia was strongly associated with TCM, compared to patients without TCM (100% vs. 20%, p < 0.001). Patients in the TCM group were younger (mean age 39 ± 22 years vs. 51 ± 17 years, p = 0.0006) and more frequently male (60% vs. 38%, p < 0.001). Patients with TCM had a longer mean tachycardia cycle length (502 ± 131 ms vs. 402 ± 105 ms, p < 0.0001) and slower ventricular rate (117 ± 21 beats/min vs. 141 ± 33 beats/min, p = 0.0007) during tachycardia compared with patients who did not have TCM. Appendage sites are associated with a high incidence of incessant tachycardia (84%) and LV dysfunction (42%). After successful ablation, LV function was restored in 97% of patients at a mean of 3 months.

Conclusions

Cardiomyopathy occurs in 10% of patients with focal AT. A slower incessant tachycardia is more frequently complicated by cardiomyopathy. Long-term restoration of LV function can be achieved after successful catheter ablation of the tachycardia focus.

Key Words

atrial tachycardia
cardiomyopathy
tachycardia-mediated cardiomyopathy

Abbreviations and Acronyms

AT
atrial tachycardia
AV
atrioventricular
EP
electrophysiology
LV
left ventricular
LVEF
left ventricular ejection fraction
RFA
radiofrequency ablation
TCL
tachycardia cycle length
TCM
tachycardia-mediated cardiomyopathy

Cited by (0)

Dr. Medi has received a scholarship from the Cardiac Society of Australia and New Zealand, a medical post-graduate scholarship from the National Heart Foundation, and a Cardiovascular Lipid Research Grant (Pfizer Australia). Dr. Haqqani has received a Medical Postgraduate Research Scholarship from the National Health and Medical Research Council. Dr. Kistler has received research support from the Cardiac Society of Australasia.