Tachicardia-Induced Cardiomyopathy: Current Status of Diagnosis and Treatment

Abstract

Tachycardia-induced cardiomyopathy (TIC) is characterized by a decrease in left ventricular systolic function due to chronic tachyarrhythmia or frequent ventricular extrasystoles in the absence of structural heart disease.

Aim. To analyze the current literature data about TIC.

Materials. Clinical guidelines and current literature from the PubMed database on the diagnosis and treatment of TIC.

Results. Due to the lack of established TIC diagnostic criteria, the main problem remains its untimely diagnosis, as well as the difficulty in understanding whether the arrhythmia is a cause or a consequence of cardiomyopathy. The main strategy for treating TIC is to restore the heart rhythm, which can be achieved both medically and by invasive methods. Current American and European guidelines prioritize catheter ablation, which results in normalization of chamber size, increased left ventricular ejection fraction, and symptomatic resolution, which indicates reversibility of the disease. Although previous studies have recommended antiarrhythmic drugs before catheter ablation, the current evidence supports ablation as the first-line therapy for AF. A more stringent heart rate control strategy is appropriate (target heart rate <80 bpm at rest and <110 bpm during moderate exercise). AV node ablation with pacemaker implantation provides safe and effective heart rate control in patients with AF whose heart rate cannot be effectively controlled with catheter ablation and medical therapy.