Diffuse Ventricular Fibrosis Is a Late Outcome of Tachycardia-Mediated Cardiomyopathy After Successful Ablation

作者：Ling Liang han; Kalman Jonathan M^*; Ellims Andris H; Iles Leah M; Medi Caroline; Sherratt Craig; Kaye David M; Hare James L; Kistler Peter M; Taylor Andrew J

来源：Circulation-Arrhythmia and Electrophysiology, 2013, 6(4): 697-704.

DOI：10.1161/CIRCEP.113.000681

• ablation
• cardiomyopathies
• MRI
• tachycardia
• T1 mapping

Background-Successful arrhythmia ablation normalizes ejection fraction (EF) in tachycardia-mediated cardiomyopathy, but recurrent heart failure and late sudden death have been reported. The aim of this study was to characterize the left ventricle (LV) of tachycardia-mediated cardiomyopathy patients long after definitive arrhythmia cure.
Methods and Results-Thirty-three patients with a history of successfully ablated incessant focal atrial tachycardia 64 +/- 36 months prior, and 20 healthy controls were recruited. At ablation, 18 patients had EF<50% (AT-low EF) that recovered within 3 months from 37 +/- 12 to 56 +/- 4% (P<0.001), whereas 15 patients had EF>55% (AT-normal EF). No subjects had EF of 50% to 55%. Subjects underwent echocardiography with speckle tracking and contrast-enhanced cardiac MRI with ventricular T-1 mapping as an index of diffuse fibrosis. Contrast-enhanced cardiac MRI was performed using a clinical 1.5-T scanner and 0.2 mmol/kg gadolinium-diethylene triamine penta-acetic acid for contrast. Subject characteristics were similar across the 3 groups. Compared with AT-normal EF patients and controls, AT-low EF patients had lower EF (60 +/- 6 versus 64 +/- 4 and 65 +/- 4%; P<0.05), greater indexed LV end-diastolic volume (102 +/- 34 versus 84 +/- 14 and 85 +/- 16 mL/m(2); P<0.05), and greater indexed LV end-systolic volume (41 +/- 11 versus 31 +/- 7 and 30 +/- 8 mL/m(2); P<0.01) on contrast-enhanced cardiac MRI. Compared with controls, AT-low EF patients had reduced global LV corrected T-1 time (442 +/- 53 versus 529 +/- 61; P<0.05) consistent with diffuse fibrosis.
Conclusions-Tachycardia-mediated cardiomyopathy patients exhibit differences in LV structure and function including diffuse fibrosis long after arrhythmia cure, indicating that recovery is incomplete.

• 出版日期2013-8