Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2017 Oct;103(19):1543-1552.
doi: 10.1136/heartjnl-2016-310391. Epub 2017 Aug 30.

Pathophysiology, diagnosis and treatment of tachycardiomyopathy

Claire A Martin  1 , Pier D Lambiase  1
Affiliations
Review

Pathophysiology, diagnosis and treatment of tachycardiomyopathy

Claire A Martin et al. Heart. 2017 Oct.
No abstract available

Keywords: atrial arrhythmia ablation procedures; cardiac magnetic resonance (cmr) imaging; heart failure; idiopathic dilated cardiomyopathy; ventricular arrhythmia ablation procedures.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Arrhythmias leading to left ventricular dysfunction. AF, atrial fibrillation; LBBB, left bundle branch block; PVCs, premature ventricular complexes; RBBB, right bundle branch block; RV, right ventricular; SVT, supraventricular tachycardia.
Figure 2
Figure 2
Mechanisms of tachycardiomyopathy (TCMP). The molecular, microscopic and structural effects of TCMP.
Figure 3
Figure 3
Case vignettes. (1) A man aged 33 years presented complaining of a pulsation in his neck but no other symptoms. (A) MRI demonstrated a markedly dilated left ventricle (LV) and severely impaired biventricular function with extensive mid-wall fibrosis in keeping with a dilated cardiomyopathy. Coronary angiography was normal. (B) ECG demonstrated an incessant idiopathic ventricular rhythm. Electrophysiological studies (EPS) demonstrated a focal source at the right ventricular inflow (note the left bundle branch block pattern with Q waves in the inferior leads indicative of this focus). (C) Ablation at this location terminated the tachycardia and at follow-up his LV function had normalised. (2) A female aged 25 years suffered a cardiac arrest post partum, having had a 2-week preceding history of incessant palpitations. (D) ECG demonstrated a regular narrow complex tachycardia, which was terminated with a synchronised shock. (E) Echocardiogram demonstrated a dilated and severely impaired LV. (F) EPS demonstrated AVNRT with 2:1 and 1:1 conduction. Slow pathway modification terminated the tachycardia and at follow-up LV function has normalised.  (3) A man aged 54 years presented with a 3-month history of rapidly deteriorating breathlessness and palpitations. (G) MRI demonstrated dilated and severely impaired LV (see supplementary file video 1). (H) ECG demonstrated AF with a fast ventricular response. He was rate-controlled with beta-blockers and underwent urgent ablation comprising bilateral wide area circumferential ablation, roof line and mitral isthmus line. He has subsequently maintained sinus rhythm and his LV function has gradually normalised (I) (see online supplementary video 2).
Figure 4
Figure 4
Effect of pulmonary vein isolation (PVI) vs AVN ablation+cardiac resynchronisation on left ventricular function and exercise tolerance in the Pulmonary Vein Antrum Isolation versus AV Node Ablation with Bi-Ventricular Pacing for Treatment of Atrial Fibrillation in Patients with Congestive Heart Failure (PABA CHF) trial. From Khan et al.
Figure 5
Figure 5
Premature ventricular complex (PVC) burden threshold likely to identify cases most likely to ablation to improve left ventricular function. A 13% baseline PVC burden had 100% sensitivity and 85% specificity to predict an absolute increase ≥5% in LV ejection fraction (LVEF) after sustained successful ablation (SSA). From Penela et al.
Figure 6
Figure 6
Premature ventricular complex burden effects on cardiac resynchronisation response. From Ruwald et al.
Figure 7
Figure 7
Outline of management strategy for tachycardiomyopathy. Heart failure (HF) and prevention of sudden cardiac death in structural heart disease management should be followed as per the European Guidelines. (Adapted from Gopinathannair et al ; see European Guidelines on HF and prevention of sudden cardiac death (SCD)84). AF, atrial fibrillation; LV, left ventricular; PVC, premature ventricular complex; SVT, supraventricular tachycardia; TC, tachycardia.
See this image and copyright information in PMC

References

    1. Gallagher JJ. Tachycardia and cardiomyopathy: the chicken-egg dilemma revisited. J Am Coll Cardiol 1985;6:1172–3. 10.1016/S0735-1097(85)80328-4 - DOI - PubMed
    1. Fenelon G, Wijns W, Andries E, et al. . Tachycardiomyopathy: mechanisms and clinical implications. Pacing Clin Electrophysiol 1996;19:95–106. 10.1111/j.1540-8159.1996.tb04796.x - DOI - PubMed
    1. Simantirakis EN, Koutalas EP, Vardas PE, et al. . Arrhythmia-induced cardiomyopathies: the riddle of the chicken and the egg still unanswered? Europace 2012;14:466–73. 10.1093/europace/eur348 - DOI - PubMed
    1. Gopinathannair R, Etheridge SP, Marchlinski FE, et al. . Arrhythmia-Induced cardiomyopathies: mechanisms, recognition, and Management. J Am Coll Cardiol 2015;66:1714–28. 10.1016/j.jacc.2015.08.038 - DOI - PMC - PubMed
    1. Shinbane JS, Wood MA, Jensen DN, et al. . Tachycardia-induced cardiomyopathy: a review of animal models and clinical studies. J Am Coll Cardiol 1997;29:709–15. 10.1016/S0735-1097(96)00592-X - DOI - PubMed

Publication types