Mechanisms and Clinical Significanceof Arrhythmia-Induced Cardiomyopathy

Publication date: Available online 1 August 2018Source: Canadian Journal of CardiologyAuthor(s): Alexandre Raymond-Paquin, Stanley Nattel, Reza Wakili, Rafik TadrosABSTRACTArrhythmia-induced cardiomyopathy (AIC) is characterized by left ventricular systolic dysfunction for which the primary cause is arrhythmia. The hallmark of AIC is its reversibility once the arrhythmia is properly controlled. Any tachyarrhythmia can potentially cause AIC (often called “tachycardiomyopathy”), with atrial fibrillation (AF) being by far the most common in clinical practice. The pathophysiological mechanisms underlying AIC need further clarification, but the available evidence, principally from animal models, implicates metabolic dysfunction due to increased oxygen requirements, neurohormonal adaptive mechanisms and cellular Ca2+ mishandling as important contributors. Tachycardia is a common denominator of most AIC-cases, but other components specific to the patient and the arrhythmia have been implicated. The diagnosis of AIC requires the exclusion of a primary causative role of other conditions such as hypertension, primary cardiomyopathies and valve disease, which may require specific pharmacological and invasive therapies. Catheter ablation is emerging as a safe and effective alternative to antiarrhythmic medication and has an established role in AIC management. Recent studies showing improved cardiac function and mortality-rate in patients with heart failure and concomitant AF dramatic...
Source: Canadian Journal of Cardiology - Category: Cardiology Source Type: research