Definition and management of arrhythmia-induced cardiomyopathy: findings from the European Heart Rhythm Association survey

Author:

Serban Teodor12ORCID,Badertscher Patrick12ORCID,du Fay de Lavallaz Jeanne12ORCID,Providencia Rui3ORCID,Migliore Federico4ORCID,Mugnai Giacomo5ORCID,Penela Diego6ORCID,Perrotta Laura7ORCID,Kühne Michael12ORCID,Sticherling Christian12ORCID,Chun Kyoung-Ryul Julian8ORCID

Affiliation:

1. Department of Cardiology, University Hospital Basel, University of Basel , Petersgraben 4, 4031 Basel , Switzerland

2. Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel , Spitalstrasse 2, 4056 Basel , Switzerland

3. Department of Cardiology, St Bartholomew’s Hospital , London , UK

4. Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova , Padova , Italy

5. Department of Cardiology, University Hospital of Verona , Verona , Italy

6. Department of Cardiology, Medical Centre Teknon, Grupo Quironsalud , Barcelona , Spain

7. Department of Cardiology, Careggi University Hospital , Florence , Italy

8. Department of Electrophysiology, Cardiology and Angiology Center Bethanien , Frankfurt , Germany

Abstract

Abstract Aims Arrhythmia-induced cardiomyopathy (AiCM) represents a subtype of acute heart failure (HF) in the context of sustained arrhythmia. Clear definitions and management recommendations for AiCM are lacking. The European Heart Rhythm Association Scientific Initiatives Committee (EHRA SIC) conducted a survey to explore the current definitions and management of patients with AiCM among European and non-European electrophysiologists. Methods and results A 25-item online questionnaire was developed and distributed among EP specialists on the EHRA SIC website and on social media between 4 September and 5 October 2023. Of the 206 respondents, 16% were female and 61% were between 30 and 49 years old. Most of the respondents were EP specialists (81%) working at university hospitals (47%). While most participants (67%) agreed that AiCM should be defined as a left ventricular ejection fraction (LVEF) impairment after new onset of an arrhythmia, only 35% identified a specific LVEF drop to diagnose AiCM with a wide range of values (5–20% LVEF drop). Most respondents considered all available therapies: catheter ablation (93%), electrical cardioversion (83%), antiarrhythmic drugs (76%), and adjuvant HF treatment (76%). A total of 83% of respondents indicated that adjuvant HF treatment should be started at first HF diagnosis prior to antiarrhythmic treatment, and 84% agreed it should be stopped within six months after LVEF normalization. Responses for the optimal time point for the first LVEF reassessment during follow-up varied markedly (1 day–6 months after antiarrhythmic treatment). Conclusion This EHRA Survey reveals varying practices regarding AiCM among physicians, highlighting a lack of consensus and heterogenous care of these patients.

Publisher

Oxford University Press (OUP)

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