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Arrhythmia-Induced Cardiomyopathy: Prevalent, Under-recognized, Reversible

Arrhythmia-induced cardiomyopathy (AIC) is a clinical condition in which a persistent tachyarrhythmia or frequent ectopy contribute to ventricular dysfunction leading to systolic heart failure. AIC can bepartially or completely corrected with adequate treatment of the culprit arrhythmia. Several molecular and cellular alterations by which tachyarrhythmias lead to cardiomyopathy have been identified. AIC can affect children and adults, can be clinicallysilent in the form of asymptomatic tachycardia with cardiomyopathy, or can present with manifest heart failure. A high index of suspicion for AIC and aggressive treatment of the culprit arrhythmia can result in resolution of heart failure symptoms and improvement in cardiac function.Recurrent arrhythmia, following recovery from the index episode, can hasten the left ventricular dysfunction andresult in HF, suggesting persistent adverse remodeling despite recovery of left ventricular function. Several aspects of AIC, such as predisposing factors, early diagnosis, preventive measures to avoid adverse remodeling, and long-term prognosis, remain unclear, and need further research.

Credits: Rahul Dhawan, MD and RakeshGopinathannair, MD, MA, FHRS Department of Internal Medicine, University of Louisville, Louisville, KY

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