We found that the only independent predictor was ventricular response during arrhythmia. We also examined the related but importantly different question of what predicts reversibility of LV dysfunction in patients with cardiomyopathy and persistent atrial flutter. However, these limitations are likely to be reduced in patients with atrial flutter rather than atrial fibrillation, due to lesser RR interval irregularity.
Alternatively, it may be due to the limitations of LV function assessment during atrial arrhythmia ( 14). This finding may reflect a greater duration of atrial flutter in patients who developed TICM. In our study, the only independent predictor of developing TICM was ‘not sinus rhythm’ at the time of the preablation LV function test (OR 6.48 ). Atrial fibrillation-induced TICM has also been shown to improve with good rate control ( 9), cardioversion ( 9– 11) or after atrial ventricular node ablation and pacemaker implantation ( 12, 13). Hsu et al ( 5) found that 42 of 58 (72%) patients with atrial fibrillation and congestive heart failure had marked improvement (defined as greater than 20% and/or normal) in ventricular function after atrial fibrillation ablation. Of those 50 patients, EF improved in 47 (94%) and normalized in 36 (72%) patients.
Recently, Gentlesk et al ( 8) studied 50 patients with decreased EF undergoing therapeutic ablation for paroxysmal or persistent atrial fibrillation. Considerably more data exist on patients with atrial fibrillation. Luchsinger and Steinberg ( 6) found that six of 11 (55%) patients with persistent atrial flutter had some degree of reversible cardiomyopathy. Our results add to the accumulating evidence that TICM is more common than previously considered. The only independent predictor of reversible LV dysfunction in patients with cardiomyopathy and persistent atrial flutter was ventricular response. The overall frequency of TICM in patients with persistent atrial flutter was 14.4%. In 75% of the patients, LV function improved to normal ( Figure 2). In the present study, 57% of patients with persistent atrial flutter demonstrated some degree of TICM. TICM is an important cause of reversible cardiomyopathy. The objectives of the present study were to examine the incidence of TICM in patients undergoing ablation for persistent typical atrial flutter, examine predictors for the development of TICM and analyze predictors of the reversibility of cardiomyopathy in patients with persistent atrial flutter and LV dysfunction. Potentially, there is a group of patients who may not require ICD implantation if LV function improves after reversal of the arrhythmia. This latter point is particularly relevant in the current era of primary prevention implantable cardioverter defibrillator (ICD) implantation. Few data related to predictors of reversibility of LV dysfunction in these patients have been published. Furthermore, some patients have TICM superimposed on underlying cardiomyopathy ( 1, 5, 6). Previously, it was considered to be a rare cause of cardiomyopathy ( 1, 3, 4). The first practice guidelines for diagnosing and managing TICM were recently published ( 2). Tachycardia-induced cardiomyopathy (TICM) is important to recognize because the left ventricular (LV) dysfunction is partially or wholly reversible ( 1).
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