Diffuse ventricular fibrosis is a late outcome of tachycardia-mediated cardiomyopathy after successful ablation

Liang Han Ling, Jonathan M. Kalman, Andris H. Ellims, Leah M. Iles, Caroline Medi, Craig Sherratt, David M. Kaye, James L. Hare, Peter M. Kistler, Andrew J. Taylor

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37 Citations (Scopus)

Abstract

Background-Successful arrhythmia ablation normalizes ejection fraction (EF) in tachycardia-mediated cardiomyopathy, but recurrent heart failure and late sudden death have been reported. The aim of this study was to characterize the left ventricle (LV) of tachycardia-mediated cardiomyopathy patients long after definitive arrhythmia cure. Methods and Results-Thirty-three patients with a history of successfully ablated incessant focal atrial tachycardia 64±36 months prior, and 20 healthy controls were recruited. At ablation, 18 patients had EF<50% (AT-low EF) that recovered within 3 months from 37±12 to 56±4% (P<0.001), whereas 15 patients had EF>55% (AT-normal EF). No subjects had EF of 50% to 55%. Subjects underwent echocardiography with speckle tracking and contrast-enhanced cardiac MRI with ventricular T1 mapping as an index of diffuse fibrosis. Contrast-enhanced cardiac MRI was performed using a clinical 1.5-T scanner and 0.2 mmol/kg gadolinium-diethylene triamine penta-acetic acid for contrast. Subject characteristics were similar across the 3 groups. Compared with AT-normal EF patients and controls, AT-low EF patients had lower EF (60±6 versus 64±4 and 65±4%; P<0.05), greater indexed LV end-diastolic volume (102±34 versus 84±14 and 85±16 mL/ m2; P<0.05), and greater indexed LV end-systolic volume (41±11 versus 31±7 and 30±8 mL/m2; P<0.01) on contrastenhanced cardiac MRI. Compared with controls, AT-low EF patients had reduced global LV corrected T1 time (442±53 versus 529±61; P<0.05) consistent with diffuse fibrosis. Conclusions-Tachycardia-mediated cardiomyopathy patients exhibit differences in LV structure and function including diffuse fibrosis long after arrhythmia cure, indicating that recovery is incomplete.

Original languageEnglish
Pages (from-to)697-704
Number of pages8
JournalCirculation: Arrhythmia and Electrophysiology
Volume6
Issue number4
DOIs
Publication statusPublished - Aug 2013
Externally publishedYes

Keywords

  • Ablation
  • Cardiomyopathies
  • MRI
  • T1 mapping
  • Tachycardia

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