Elsevier

Mayo Clinic Proceedings

Volume 75, Issue 8, August 2000, Pages 790-795
Mayo Clinic Proceedings

Original Article
Tachycardia-Related Cardiomyopathy: A Common Cause of Ventricular Dysfunction in Patients With Atrial Fibrillation Referred for Atrioventricular Ablation

https://doi.org/10.4065/75.8.790Get rights and content

Objective

To determine the frequency of tachycardia-related cardiomyopathy in patients with atrial fibrillation and systolic dysfunction referred for atrioventricular node ablation .

Patients and Methods

This prospective multicenter cohort study was conducted at 16 tertiary care centers. The ejection fraction was measured before and 3 and 12 months after atrioventricular node ablation. Patients with reduced systolic function (ejection fraction ≤45 %) before atrioventricular ablation were included in this study. Patients whose ejection fraction increased by at least 15 percentage points and to higher than 45% were considered to have tachycardia-related cardiomyopathy.

Results

Of 63 patients with systolic dysfunction, 48 had at least 1 adequate follow-up echocardiographic study. Sixteen (25%) of the 63 had marked improvement in the ejection fraction (mean ± SD change, 2718 percentage points) to a value higher than 45% after ablation.

Conclusions

Tachycardia-related cardiomyopathy is common in patients with atrial fibrillation and systolic dysfunction referred for atrioventricular node ablation. This diagnosis should be considered in all patients in whom systolic dysfunction occurs subsequent to or concomitant with onset of atrial fibrillation.

Section snippets

PATIENTS AND METHODS

The Ablate and Pace Trial was a multicenter registry of patients with refractory atrial fibrillation referred for clinically indicated radiofrequency atrioventricular node ablation and pacemaker implantation. A total of 161 patients were enrolled at 16 centers in the United States; the results of this study have been reported.9 Patients with atrial fibrillation were deemed candidates for atrioventricular node ablation if, in the opinion of the investigator, medical therapy provided inadequate

RESULTS

Sixty-three patients had systolic dysfunction (ejection fraction (≤5%) and comprised the study population. Of these, 9 died without follow-up. The mean ejection fraction in the patients who died was 30%. Six of these deaths were deemed cardiovascular: 2 sudden deaths, 2 deaths due to heart failure, and 2 deaths due to stroke. Three deaths were deemed noncardiac (prostatic cancer, pancreatitis, and chronic obstructive lung disease). One patient was lost to follow-up, and 5 either did not have

DISCUSSION

In these 63 patients with atrial fibrillation and systolic dysfunction referred for atrioventricular node ablation, systolic dysfunction was reversible in 25%. These data would suggest that reversible systolic dysfunction associated with atrial fibrillation and poor rate control, or “tachycardia-related cardiomyopathy,” is not rare and occurs in roughly one fourth of patients with atrial fibrillation and systolic dysfunction who are referred for atrioventricular ablation. In most patients who

Acknowledgments

The Ablate and Pace Trial Investigators are G. Neal Kay, MD, University of Alabama-Birmingham; Peter J. Wells, MD, Baylor University Heart Place; Mark Josephson, MD, Beth Israel Hospital; George Crossley, MD, Bowman Gray School of Medicine; David Wilber, MD, University of Chicago; Bruce Wilkoff, MD, Cleveland Clinic; Andrea Natale, MD, Durham VA Medical Center; Anne Curtis, MD, University of Florida College of Medicine; Michael Giudici, MD, Genesis Medical Center; Steven Kutalek, MD, Hahnemann

REFERENCES (29)

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The Ablate and Pace Trial (APT) was funded by Medtronic Inc, Minneapolis, Minn

Nothing in this publication implies that Mayo Foundation endorses any products of Medtronic Inc mentioned in this article

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