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Arrhythmia-induced cardiomyopathy

Cynthia M Tracy, MD
Section Editor
William J McKenna, MD
Deputy Editor
Brian C Downey, MD, FACC


Cardiomyopathies are diseases of the heart muscle, inclusive of a variety of myocardial disorders that manifest with various structural and functional phenotypes and are frequently genetic. Although some have defined cardiomyopathy to include myocardial disease caused by known cardiovascular causes (such as hypertension, ischemic heart disease, or valvular disease), current major society definitions of cardiomyopathy exclude heart disease secondary to such cardiovascular disorders [1,2]. (See "Definition and classification of the cardiomyopathies" and "Causes of dilated cardiomyopathy".)

The prognosis in patients with dilated cardiomyopathy is variable and dependent on the cause; importantly, there are some etiologies that may improve or resolve following treatment. One such cause is an arrhythmia-induced cardiomyopathy (also known as tachycardia-induced cardiomyopathy, tachycardia-mediated cardiomyopathy, and tachymyopathy), a relatively rare though well-recognized entity caused by long-standing tachycardia, which in most instances is readily treatable with a good prognosis [3]. Arrhythmia-induced cardiomyopathy has been reported with nearly all types of tachyarrhythmias and frequent ectopy, both supraventricular and ventricular [4].

A common clinical problem is determining whether the tachycardia is the primary cause of the patient's cardiomyopathy, or if the tachycardia is secondary to a cardiomyopathy of different etiology. This topic will discuss arrhythmia-induced cardiomyopathy as a primary cause of cardiomyopathy. Arrhythmias occurring in the setting of a specific cardiomyopathy are discussed separately. (See "Hypertrophic cardiomyopathy: Management of concurrent atrial fibrillation" and "Hypertrophic cardiomyopathy: Assessment and management of ventricular arrhythmias and sudden cardiac death risk" and "Clinical manifestations and diagnosis of arrhythmogenic right ventricular cardiomyopathy", section on 'Ventricular arrhythmias'.)


While the exact incidence of arrhythmia-induced cardiomyopathy remains unclear, an association between tachycardia and cardiomyopathy has been recognized for some time [5-8]. Virtually every form of supraventricular tachyarrhythmia, including ectopic atrial tachycardia, nonparoxysmal junctional tachycardia, and atrial fibrillation (AF), has been associated with reversible left ventricular dysfunction or "cardiomyopathy." The development of a cardiomyopathy has also been documented with ventricular tachyarrhythmias and frequent ectopic beats [9-11]. (See "Hemodynamic consequences of atrial fibrillation and cardioversion to sinus rhythm" and 'Frequent ectopic beats' below.)

Some insight into the prevalence of arrhythmia-induced cardiomyopathy can be derived from cohort studies of patients undergoing catheter ablation for symptomatic arrhythmias. As examples:


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