Characteristics of congestive heart failure accompanied by atrial fibrillation with special reference to tachycardia-induced cardiomyopathy.
BACKGROUND
Sustained tachycardia causes left ventricular (LV) systolic dysfunction leading to heart failure (HF), which is widely known as "tachycardia-induced cardiomyopathy (TIC)", but its prevalence and prognosis in Japanese remain unclear.


RESULTS
Of 213 consecutive patients with HF associated with atrial fibrillation (AF) requiring hospitalization (n=213) between January 1999 and December 2004, and 104 (83 males, 67+/-12.6 years) were identified as not having any structural heart disease. Of them 41 (39%) had a normal LV ejection fraction (LVEF) at the initial admission, and the remaining patients fell into 2 groups: those with rapid (<6 months) normalization of the LVEF after AF management (presumed TIC, 30 patients, 29%) and those with persistent LV systolic dysfunction (dilated cardiomyopathy (DCM), 33 patients, 32%). Although the B-type natriuretic peptide value and LVEF did not differ between the 2 groups, the LV size on admission was significantly smaller in the TIC group (LV end-diastolic dimension (LVDd) 57.6+/-7.2, LV end-systolic dimension (LVDs) 49.4+/-8.0) than in the DCM group (LVDd 63.4 +/-8.8, LVDs 55.3+/-9.6, p<0.05). During a follow-up period of 42.1+/-21.2 months, cardiac death and recurrent HF hospitalization were significantly less frequent in the TIC group than in the DCM group.


CONCLUSIONS
In AF-associated HF requiring hospitalization, TIC is the presumed cause in approximately one-third of patients without any previously known structural heart disease. That particular group is characterized by a relatively smaller LV and better prognosis under medical treatment.
Fujino
Tadashi
T
Cardiovascular Institute Hospital, Department of Cardiovascular Medicine, Toho University Omori Medical Center, 6-11-1 Omorinishi, Ota-ku, Tokyo 143-8541, Japan. fujino1101@med.toho-u.ac.jp
Yamashita
Takeshi
T
Suzuki
Shinya
S
Sugiyma
Hiroaki
H
Sagara
Koichi
K
Sawada
Hitoshi
H
Aizawa
Tadanori
T
Igarashi
Masaki
M
Yamazaki
Junichi
J
D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People; D001281:Atrial Fibrillation / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy; D009202:Cardiomyopathies / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011379:Prognosis; D013610:Tachycardia / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D016277:Ventricular Function, Left
D020097:Natriuretic Peptide, Brain