A Clinical Case of Complex Treatment for Tachycardia-Induced Cardiomyopathy

Abstract

Introduction. Tachycardia-induced cardiomyopathy (TIC) is characterized by impaired left ventricular systolic function caused by chronic tachyarrhythmia or frequent ventricular extrasystoles in the absence of structural heart disease.Aim. To present a complex treatment approach in a patient with tachycardia-induced cardiomyopathy.Clinical case description. A 50-year-old patient presented with a significantly reduced left ventricular ejection fraction (LVEF) of 22-25 %, severe tricuspid regurgitation, moderate mitral regurgitation, and pulmonary hypertension (pulmonary artery systolic pressure [PASP], 53 mmHg) associated with persistent atrial fibrillation/flutter. After further evaluation, TIC was diagnosed, guideline-directed medical therapy (GDMT) for heart failure was initiated, and linear radiofrequency catheter ablation of the cavotricuspid isthmus was performed. NT-proBNP was 1594 pg/mL at admission and decreased to 459.1 pg/mL at discharge. Six months after the procedure, patient maintains sinus rhythm, NTproBNP is 9.85 pg/mL. Echocardiography revealed a high left ventricular contractility (LVEF 64 %), mild mitral and tricuspid regurgitation, and no significant pulmonary hypertension (PASP 30 mmHg).Conclusions. Our clinical case demonstrates successful radiofrequency ablation of cavotricuspid isthmus and GDMT in a patient with TIC. Preservation of sinus rhythm was associated with progressive improvement of left ventricle ejection fraction, and quality of life, as well as resolution of clinical symptoms. NTproBNP is a strong marker of heart failure which qualitatively reflects the dynamics of the process and can be used to assess the effectiveness of therapy.