Tachycardia-induced cardiomyopathy is a systolic cardiac dysfunction given by prolonged elevated heart rates in patients with incessant or frequent tachyarrhythmias. Arrhythmias associated with tachycardiomyopathy can be either supraventricular (atrial tachycardia, atrial flutter, atrial fibrillation, AVNRT, permanent junctional reciprocating tachycardia, high rates of atrial pacing) or ventricular (frequent premature ventricular complexes, right ventricular outflow tract tachycardia, LVOT, left ventricular fascicular tachycardia, bundle-branch reentry or high rate of ventricular pacing). Electrophysiological study confirms the clinical diagnosis of tachycardia-induced cardiomyopathy, reveals the arrhythmia mechanism and facilitates catheter ablation that results in complete recovery of ventricular function. This chapter has two parts: 1. Theoretical insight into the pathogenesis of tachycardia-induced cardiomyopathy, clinical manifestations and therapy. 2. Practical issues: we describe our EP lab’s experience on electrophysiological study and ablation in patients with tachycardia-induced cardiomyopathy. We will present five cases of ablation: PVCs >30,000/24 h, antidromic tachycardia, 2:1 atrial flutter, persistent atrial fibrillation and RVOT PVCs with nonsustained VT.
Part of the book: The Role of the Clinical Cardiac Electrophysiologist in the Management of Congestive Heart Failure