Tachycardia-induced cardiomyopathy: a review of animal models and clinical studies

Department of Medicine, University of California San Francisco 94143-1354, USA.

The increasing prevalence of congestive heart failure has focused importance on the search for potentially reversible etiologies of cardiomyopathy. The concept that incessant or chronic tachycardias can lead to ventricular dysfunction that is reversible is supported by both animal models of chronic rapid pacing as well as human studies documenting improvement in ventricular function with tachycardia rate or rhythm control. Sustained rapid pacing in experimental animal models can produce severe biventricular systolic dysfunction. Hemodynamic changes occur as soon as 24 h after rapid pacing, with continued deterioration in ventricular function for up to 3 to 5 weeks, resulting in end-stage heart failure. The recovery from pacing-induced cardiomyopathy demonstrates that the myopathic process associated with rapid heart rates is largely reversible. Within 48 h after termination of pacing, hemodynamic variables approach control levels, and left ventricular ejection fraction shows significant recovery with subsequent normalization after 1 to 2 weeks. In humans, descriptions of reversal of cardiomyopathy with rate or rhythm control of incessant or chronic tachycardias have been reported with atrial tachycardias, accessory pathway reciprocating tachycardias, atrioventricular (AV) node reentry and atrial fibrillation (AF) with rapid ventricular responses. Control of AF rapid ventricular responses has been demonstrated to improve ventricular dysfunction with cardioversion to sinus rhythm, pharmacologic ventricular rate control and AV junction ablation and permanent ventricular pacing. The investigation of potential tachycardia-induced cardiomyopathy in patients with heart failure requires further prospective confirmation in larger numbers of patients, with study of mechanisms, patient groups affected and optimal therapies.

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				H. J. Patel, J. J. Pilla, D. J. Polidori, S. V. Pusca, T. A. Plappert, M. S. J. Sutton, E. B. Lankford, and M. A. Acker TEN WEEKS OF RAPID VENTRICULAR PACING CREATES A LONG-TERM MODEL OF LEFT VENTRICULAR DYSFUNCTION J. Thorac. Cardiovasc. Surg., April 1, 2000; 119(4): 834 - 841. [Abstract] [Full Text] [PDF]

				M. A. Wood, C. Brown-Mahoney, G. N. Kay, and K. A. Ellenbogen Clinical Outcomes After Ablation and Pacing Therapy for Atrial Fibrillation : A Meta-Analysis Circulation, March 14, 2000; 101(10): 1138 - 1144. [Abstract] [Full Text] [PDF]

				T. R. Engel and S. Radhagopalan Treatment of Multifocal Atrial Tachycardia by Treatment of Pulmonary Insufficiency : Or Is it Vice Versa? Chest, January 1, 2000; 117(1): 7 - 8. [Full Text] [PDF]

				N. Kobayashi, T. Higashi, K. Hara, H. Shirataki, and H. Matsuoka Effects of imidapril on NOS expression and myocardial remodelling in failing heart of Dahl salt-sensitive hypertensive rats Cardiovasc Res, December 1, 1999; 44(3): 518 - 526. [Abstract] [Full Text] [PDF]

				W. G. Stevenson and L. W. Stevenson Atrial Fibrillation in Heart Failure N. Engl. J. Med., September 16, 1999; 341(12): 910 - 911. [Full Text]

				G. W Moe and P. Armstrong Pacing-induced heart failure: a model to study the mechanism of disease progression and novel therapy in heart failure Cardiovasc Res, June 1, 1999; 42(3): 591 - 599. [Full Text] [PDF]

				D. Dries, D. Exner, B. Gersh, M. Domanski, M. Waclawiw, and L. Stevenson Atrial fibrillation is associated with an increased risk for mortality and heart failure progression in patients with asymptomatic and symptomatic left ventricular systolic dysfunction: a retrospective analysis of the SOLVD trials J. Am. Coll. Cardiol., September 1, 1998; 32(3): 695 - 703. [Abstract] [Full Text] [PDF]

				H. Sun, R. Gaspo, N. Leblanc, and S. Nattel Cellular Mechanisms of Atrial Contractile Dysfunction Caused by Sustained Atrial Tachycardia Circulation, August 18, 1998; 98(7): 719 - 727. [Abstract] [Full Text] [PDF]

				T. Neumann and G. Heusch Myocardial, skeletal muscle, and renal blood flow during exercise in conscious dogs with heart failure Am J Physiol Heart Circ Physiol, November 1, 1997; 273(5): H2452 - H2457. [Abstract] [Full Text] [PDF]