Journal Article

Right Ventricular Systolic Dysfunction Predicts Recovery of Left Ventricular Systolic Function and Reduced Quality of Life in Patients With Arrhythmia‐Induced Cardiomyopathy

Wachter, Rolf, Körtl, Thomas, Meindl, Christine, Maier, Lars S., Baum, Paul, Üçer, Ekrem, Mühleck, Franziska, Sossalla, Samuel, Schach, Christian, Resch, Markus

2025

Overview

Introduction Arrhythmia‐induced cardiomyopathy (AIC) is an underrecognized condition resulting in left ventricular systolic dysfunction (LVSD) that is primarily caused by atrial fibrillation (AFib). The relationship between AIC, right ventricular (RV) function, and quality of life (QoL) has not been well studied. Methods We performed a post‐hoc analysis of our AIC trial in which we prospectively screened for patients with tachyarrhythmia and newly diagnosed, otherwise unexplained LVSD. Following rhythm restoration, patients were followed up at 2, 4, and 6 months. Only patients with persistent sinus rhythm were analyzed. RV function was assessed via echocardiography (tricuspid annular plane systolic excursion [TASPE] and fractional area change [FAC]) and QoL by the Minnesota Living with Heart Failure Questionnaire. Results Of a total of 50 patients recovering from LVSD, 41 were diagnosed with AIC and 9 with non‐AIC. Initially, RV function was reduced in the AIC group and recovered after rhythm restoration, whereas no relevant changes were noted in the non‐AIC group. QoL was reduced in both groups and also improved after rhythm restoration. Regression analysis identified low TAPSE as a predictive parameter for AIC diagnosis and worse QoL in AIC patients. Conclusion We demonstrated that RV function and QoL are impaired in patients with AIC. Six months after rhythm restoration, TAPSE may serve as an early indicator of AIC while also correlating with QoL. This underscores the importance of detailed echocardiographic evaluation with a focus on RV function in patients with concomitant tachyarrhythmia and LVSD. Initial tricuspid annular plane systolic excursion (TAPSE), quality of life (QoL) as measured by the Minnesota Living with Heart Failure Questionnaire and left ventricular ejection fraction (LVEF) during atrial fibrillation (AFib) or atrial flutter (AFlut) were reduced in patients with arrhythmia‐induced cardiomyopathy (AIC) compared with values at the end of 6 months of follow‐up in sinus rhythm. In this paper we show that low TAPSE (optimal cut‐off 18.5 mm) has good predictive power for the diagnosis of AIC and that a low quality of life is associated with low TAPSE. Values in red indicate the relative percent the baseline values were reduced compared with the post‐recovery measurement at the end of follow‐up.

• Publisher: John Wiley & Sons, Inc,John Wiley and Sons Inc
• Subject: Aged / Arrhythmias, Cardiac - complications / Arrhythmias, Cardiac - physiopathology / arrhythmia‐induced cardiomyopathy / atrial fibrillation / Cardiac arrhythmia / Cardiomyopathies - diagnosis / Cardiomyopathies - etiology / Cardiomyopathies - physiopathology / Cardiomyopathies - psychology / Cardiomyopathy / Clinical Trial Result / Echocardiography / Female / Follow-Up Studies / Heart failure / Heart rate / Humans / Male / Medical imaging / Middle Aged / Prospective Studies / Pulmonary arteries / Quality of Life / Questionnaires / Recovery of Function / right ventricular function / Stroke Volume / Systole / Time Factors / Ventricular Dysfunction, Left - etiology / Ventricular Dysfunction, Left - physiopathology / Ventricular Dysfunction, Right - diagnosis / Ventricular Dysfunction, Right - etiology / Ventricular Dysfunction, Right - physiopathology / Ventricular Dysfunction, Right - psychology / Ventricular Function, Left - physiology / Ventricular Function, Right - physiology