Figuring out complete left ventricular reverse remodeling in tachycardiomyopathy

Tachycardiomyopathy is a common cause of left ventricular systolic dysfunction (LVSD), whose complete resolution after arrhythmia control is highly variable among patients.

To assess the associated factors with complete left ventricular reverse remodeling (CLVRR) in patients with confirmed tachycardiomyopathy.

Retrospective single-centre, observational study of consecutive patients with diagnosed tachycardiomyopathy between January 2015–2022. CLVRR was defined by a recovered left ventricular ejection fraction (RLVEF) >55% and a left ventricular end-dyastolic diameter (LVEDD) <55 mm assessed by transthoracic echocardiography.

134 patients were gathered in this period. Patients with previous known LVSD or LV dilatation were excluded from the analysis (n=6). Baseline characteristics are displayed in Image 1. Most frequent arrhythmia was atrial fibrillation (73.8%), followed by atrial flutter (25.4%), atrial tachycardia (2.2%) and ventricular extrasystole (5.2%). 99.2% of patients were treated with beta-blockers, 71.6% with ACEI/ARBs, 23.9% with neprilysin inhibitors and 64.2 with aldosterone receptor antagonist. Rhythm control was achieved in 82.1% of patients, of whom 80% underwent an ablation procedure after a mean of 8.2 months. After 10.8 months since LVSD, mean RLVEF was 55.4% (+6.3) and mean LVEDD 52.1 mm (+5.8). CLVRR was observed in 50% of patients. A multivariate analysis was performed in a stepwise fashion to assess associated factors, including baseline information (medical history, echocardiographic information and received treatment, both pharmacological and ablation). CLVRR was associated with female-sex (coefficient 1.18; p=0.009) and severe baseline left ventricular disfunction (coefficient −0.80; p=0.041), corrected by previous alcohol abuse history (coefficient 0.94; p=0.055) and a rhythm-control strategy (coefficient 0.98; p=0.052) which didn't reach complete statistical significance.

Women, patients without severe LV dysfunction at baseline, with history of previous alcohol abuse and receiving a rhythm-control strategy were associated with a complete left ventricular reverse remodeling in patients with tachycardiomyopathy.

Type of funding sources: None.