Blaauw, Y.

Crijns, H. J. G. M.

Mafirad, M.

van Opstal, J. M.

English

PubMed

M. Mafirad

Y. Blaauw

J. M. van Opstal

H. J. G. M. Crijns

Springer - Publisher Connector

Haemodynamic bradycardia in tachycardiomyopathy

IMAGING IN CARDIOLOGY
Haemodynamic bradycardia in tachycardiomyopathy
M. Mafirad & Y. Blaauw & J. M. van Opstal &
H. J. G. M. Crijns
Published online: 17 May 2011
# The Author(s) 2011. This article is published with open access at Springerlink.com
A 44-year-old man presented with a 6-month history of
progressive dyspnoea (NYHA class III). The electrocar-
diogram showed sinus rhythm with continuous short
runs of atrial tachycardia resulting in a heart rate of 200
beats/min (Fig. 1a). An echocardiogram demonstrated
left ventricular dilatation and a reduced ejection fraction
of 15–25%. During runs of atrial tachycardia, the mitral
valve failed to open due to high end-diastolic pressures,
resulting in impaired filling of the left ventricle (Fig. 1b).
As a consequence there was a virtual absence of blood
flow through the aortic valve during tachycardic runs
(Fig. 1c). Effective cardiac output was only seen during
sinus beats, which came at a rate of 25–30 beats per
minute. The patient was diagnosed with tachycardiomy-
opathy due to incessant atrial tachycardia. Cryoablation
of the atrial focus eliminated the tachycardia. Three
months later, tachycardias were still absent and the
patient’s left ventricular systolic function and clinical
condition had markedly improved.
Tachycardiomyopathy is an abnormality of systolic and/or
diastolic function of the heart, resulting in atrial and ventricular
dilatation and ultimately development of heart failure symp-
M. Mafirad (*) :Y. Blaauw : J. M. van Opstal :
H. J. G. M. Crijns
Department of cardiology, Maastricht University Medical Centre,
P. Debeyelaan 25,
6229 HX, Maastricht, the Netherlands
e-mail: m.mafirad@alumni.unimaas.nl
Neth Heart J (2012) 20:184–185
DOI 10.1007/s12471-011-0146-9
toms. Tachycardiomyopathy is usually caused by atrial
arrhythmias that results in a high and/or irregular ventricular
rate. Myocardial dysfunction is completely or partially revers-
ible after normalisation of heart rate and/or rhythm irregularity
[1]. The mechanisms responsible for the contractile dysfunc-
tion and structural changes in tachycardiomyopathy are not
yet fully understood. This case illustrates the direct effect of
tachyarrhythmia on cardiac function and its haemodynamic
consequences in a patient with tachycardiomyopathy.
Open Access This article is distributed under the terms of the
Creative Commons Attribution Noncommercial License which per-
mits any noncommercial use, distribution, and reproduction in any
medium, provided the original author(s) and source are credited.
References
1. Brugada P, Andries E. “Tachycardiomyopathy”. The most frequently
unrecognized cause of heart failure? Acta Cardiol. 1993;2:165–9.
Fig. 1 a Rhythm strip demonstrating sinus rhythm and episodes of atrial tachycardia. b and c) Echocardiogram with apical views demonstrating
absence of flow through the mitral valve and aortic valve during a run of atrial tachycardia
Neth Heart J (2012) 20:184–185 185


The most frequently unrecognized cause of heart failure? Acta Cardiol.

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Haemodynamic bradycardia in tachycardiomyopathy

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