Alev ARSLAN, İlkay ERDOĞAN, Birgül VARAN, Mustafa YILMAZ, Mehmet Bülent ÖZİN, Niyazi Kürşad TOKEL

Reversible cardiomyopathy-tachycardiomyopathy in children

Tachycardia-induced cardiomyopathy (tachycardiomyopathy) is definedby the presence of a sustained tachycardia that results in left ventricularsystolic dysfunction. Restoration of cardiac function is dependent on thecontrol of tachyarrhythmias. We report a series including ten children withtachycardia-induced cardiomyopathy with different etiologies. The medicalrecords of patients with tachycardiomyopathy who were managed in aPediatric Cardiology Clinic between the years of 2014-2017 were reviewedretrospectively. Ten children (3 female, 7 male) were diagnosed withtachycardiomyopathy. The median age of the patients was 12 years (range:4–15.8). Five had atrial tachycardia, two had ventricular tachycardia, theothers had Mahaim fiber tachycardia, permanent junctional reciprocatingtachycardia and atrioventricular reentrant tachycardia. Seven patients hadcatheter ablation and three patients who had previous heart surgery weretreated with antiarrhythmic drugs. Median ejection fraction was 33% (range:10-48), median left ventricle end-diastolic diameter was 55 mm (range: 30-78).All showed complete recovery with median ejection fraction 60% (range: 55-78). Two patient with severe heart failure required extracorporeal membraneoxygenation support, one of them had ventricular assist device support butthe device was removed after successful ablation. After two years this patientrequired permanent pacemaker implantation due to complete atrioventricularblock. Tachycardia-induced cardiomyopathy is a rare and treatable causeof heart failure. Early recognition is critical, aggressive treatment aimed atcontrolling the arrhythmia results in symptom resolution and recovery ofventricular function.

PDF

___

1. Fenelon G, Wijns W, Andries E, Brugada P. Tachycardiomyopathy: Mechanisms and clinical applications. Pacing Clin Electrophysiol 1996; 19: 95- 106.

2. Moore JP, Patel PA, Shannon KM, et al. Predictors of myocardial recovery in pediatric tachycardia-induced cardiomyopathy. Heart Rhythm 2014; 11: 1163-1169.

3. Gopinathannair R, Etheridge SP, Marchlinski FE, Spinale FG, Lakkireddy D, Olshansky B. Arrhythmiainduced cardiomyopathies: Mechanisms, recognition, and management. J Am Coll Cardiol 2015; 66: 1714- 1728.

4. Friedman RA, Walsh EP, Silka MJ et al. NASPE Expert Consensus Conference: Radiofrequency catheter ablation in children with and without congenital heart disease. Report of the writing committee. North American Society of Pacing and Electrophysiology. Pacing Clin Electrophysiol 2002; 25: 1000-1017.

5. Corrado D, Basso C, Thiene G. Arrhythmogenic right ventricular cardiomyopathy: Diagnosis, prognosis, and treatment. Heart 2000; 83: 588-595.

6. Aizawa Y, Suzuki K, Chinushi M, Shibata A. AV nodal reentrant tachycardia with a bystander Mahaim fiber. Jpn Heart J 1988; 29: 891-896.

7. Dorostkar PC, Silka MJ, Morady F, Dick M 2nd. Clinical course of persistent junctional reciprocating tachycardia. J Am Coll Cardiol 1999; 33: 366-375.

8. Aykan HH, Karagöz T, Akın A, İrdem A, Özer S, Çeliker A. Results of radiofrequency ablation in children with tachycardia-induced cardiomyopathy. Anadolu Kardiyol Derg 2014; 14: 625-630.

9. Vaksmann G, D'Hoinne C, Lucet V, et al. Permanent junctional reciprocating tachycardia in children: A multicentre study on clinical profile and outcome. Heart 2006; 92: 101-104.

10. Bonney WJ, Shah MJ. Incessant SVT in children: Ectopic atrial tachycardia and permanent junctional reciprocating tachycardia. Prog Pediatr Cardiol 2013; 35: 33-40.

11. Ohe T, Aihara N, Kamakura S, Kurita T, Shimizu W, Shimomura K. Long-term outcome of verapamilsensitive sustained left ventricular tachycardia in patients without structural heart disease. J Am Coll Cardiol 1995; 25: 54-58.

12. Frey B, Kreiner G, Gwechenberger M, Gössinger HD. Ablation of atrial tachycardia originating from the vicinity of the atrioventricular node: Significance of mapping both sides of the interatrial septum. J Am Coll Cardiol 2001; 38: 394-400.

13. Deanfield J, Camm J, Macartney F, et al. Arrhythmia and late mortality after Mustard and Senning operation for transposition of the great arteries. J Thorac Cardiovasc Surg 1988; 96: 569-576.

14. Gewillig M, Wyse RK, de Leval MR, J E Deanfield. Early and late arrhythmias and the Fontan operation: Predisposing factors and clinical consequences. Br Heart J 1992; 67: 72-79.

15. Nerheim P, Birger-Botkin S, Piracha L, Olshansky B. Heart failure and sudden death in patients with tachycardia-induced cardiomyopathy and recurrent tachycardia. Circulation 2004; 110: 247-252.

16. Shebani SO, Ng GA, Stafford P, Duke C. Radiofrequency ablation on veno-arterial extracorporeal life support in treatment of very sick infants with incessant tachymyopathy. Europace 2015; 17: 622-627.

17. Gultekin B, Ersoy O, Ozkan M, Akkaya I, Umaroglu S, Sezgin A. Left ventricular assist device results: Single center experience. Exp Clin Transplant 2015; 13(Suppl 3): 149-152.