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Arrhythmia-Induced Cardiomyopathy: Mechanisms and Risk Assessment to Guide Management and Follow-Up

  • Arrhythmias (J. Bunch, Section Editor)
  • Published:
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Abstract

Purpose of Review

Arrhythmia-induced cardiomyopathy (AIC) is a condition where left ventricular (LV) systolic dysfunction is caused by or worsened by atrial or ventricular arrhythmias. While recognition of AIC has grown over time, the identification of patients at risk for AIC remains an ongoing challenge. The purpose of this review is to explore mechanisms and types of AIC, discuss risk factors for the development of AIC, and features that predict clinical improvement.

Recent Findings

Prompt recognition and treatment of the culprit arrhythmia can result in partial or complete recovery of LV function. In atrial fibrillation (AF), the movement towards early rhythm-control has been fueled by studies where catheter ablation decreases heart failure (HF) hospitalization, facilitates recovery of LV function, and reduces AF recurrence when compared to medical therapy. A recent multicenter study comparing an early rhythm-control strategy to usual care in AF found that early rhythm-control was associated with a lower risk of adverse outcomes including death from cardiovascular causes, stroke, or HF hospitalization. Integrating cardiac magnetic resonance (CMR) in the evaluation of non-ischemic cardiomyopathy may identify patients with AIC. In patients with AIC secondary to premature ventricular complexes (PVCs) or AF, the absence of late gadolinium enhancement (LGE) may predict recovery of LV function following arrhythmia treatment.

Summary

Risk assessment for AIC requires characterization of features such as symptoms, arrhythmia type, duration, and rates. Patients at risk include those with a prior history of AIC or LV dysfunction and those with a significant PVC burden. The presence of (LGE) on cardiac magnetic resonance (CMR) may identify patients with AIC and those at risk for incomplete recovery even following arrhythmia treatment.

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Authors and Affiliations

  1. School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA

    Luke Chong

  2. Kansas City Heart Rhythm Institute, Overland Park, KS, USA

    Rakesh Gopinathannair

  3. Saint Louis University School of Medicine, St Louis, MO, USA

    Ali Ahmad & Philip Mar

  4. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA

    Ali Ahmad

  5. University of Iowa Hospitals and Clinics, Iowa City, IA, USA

    Brian Olshansky

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  1. Luke Chong
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  2. Rakesh Gopinathannair
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  3. Ali Ahmad
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  4. Philip Mar
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  5. Brian Olshansky
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Correspondence to Rakesh Gopinathannair.

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Conflict of Interest

Luke Chong MD, Ali Ahmad MD, and Philip Mar MD, PharmD do not have any conflicts of interests to disclose. Brian Olshansky MD, FHRS has served as a consultant for Sanofi Aventis, a consultant and speaker for Lundbeck, a coordinator for Boehringer Ingelheim (US Co-coordinator GLORIA AF), and on the data safety and monitoring board for Amarin (DSMB REDUCE-IT) and Astra Zeneca (DSMB azDIALYZEd). Rakesh Gopinathannair MD, MA, FHRS has served as a consultant and speaker for Abbott Medical, Boston Scientific, Sanofi, and Zoll Medical, and has also served on the advisory board for PaceMate.

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Chong, L., Gopinathannair, R., Ahmad, A. et al. Arrhythmia-Induced Cardiomyopathy: Mechanisms and Risk Assessment to Guide Management and Follow-Up. Curr Cardiovasc Risk Rep 16, 121–129 (2022). https://doi.org/10.1007/s12170-022-00699-7

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