Elsevier

The American Journal of Cardiology

Volume 159, 15 November 2021, Pages 72-78
The American Journal of Cardiology

Supraventricular Tachycardia Causing Left Ventricular Dysfunction

https://doi.org/10.1016/j.amjcard.2021.08.026Get rights and content

There is limited evidence on characterization and natural history of supraventricular tachycardia (SVT)-induced left ventricular (LV) dysfunction. The aim of this work was to characterize clinical features and long-term evolution of SVT-induced LV dysfunction. Patients consecutively admitted with sustained SVT and heart rate >100 bpm as the only known cause of a new onset LV systolic dysfunction (i.e., LV ejection fraction [EF] <50%) were analyzed. Patients were then revaluated periodically. Recovered LVEF (i.e., ≥50%) and a composite of death, heart transplant or first episode of major ventricular arrhythmias were evaluated as study end-points. We enrolled 83 patients. After SVT therapy, 56 (67%) showed a recovered LVEF at the last follow-up of median 54 (interquartile range 36 to 87) months. Seventeen (30%) of those patients had a temporary new drop in LVEF during follow-up associated to high-rate SVT relapse. At presentation, patients with recovered LVEF were younger (52 vs 67 years respectively, p <0.001) and had higher LVEF (34% vs 27% respectively, p = 0.005) compared to non-recovered LVEF patients. Finally, 4% of recovered LVEF patients vs 26% of nonrecovered LVEF patients experienced death/heart transplant/major ventricular arrhythmias during follow-up (p = 0.004). In conclusion, after almost 5 years of follow-up, two-thirds of patients with high-rate SVT causing a newly diagnosed LV systolic dysfunction recovered and maintained normal LV function after SVT control, with a subsequent benign outcome. Long term individual surveillance is required in those patients, as arrhythmic recurrences and new drops in LVEF are common in the long term.

Section snippets

Methods

All consecutive patients admitted for new-onset LV systolic dysfunction and concomitant evidence of sustained SVT with heart rate >100 bpm from January 2005 to December 2016 in the Cardiovascular Department of the University Hospital of Trieste were analyzed. Patients included in the study presented with LVEF <50% at baseline evaluation in the absence of any other known possible causes of systolic dysfunction. Therefore, patients with significant coronary artery disease, history of uncontrolled

Results

The study population included 83 patients. The complete baseline characteristics are summarized in Table 1 and Figure 1. Eighty-seven percent (72) patients underwent to effective rhythm control (27 patients with catheter ablation, 40 with DCCV and 5 with anti-arrhythmic drugs). The remaining 11 (13%) were treated with a rate control strategy for refusal by patients, persistent left atrium appendage/endo-ventricular thrombosis, ineffective rhythm control.

Enrolled patients were revaluated for a

Discussion

The main results of our study are: (1) 67% of patients presenting with new-onset LV dysfunction associated to high-rate sustained SVT as the only known possible cause, showed LVEF recovery after arrhythmia management at a median follow-up of > 4 years; (2) patients with recovered LVEF showed a higher overall survival rate with respect to patients with non-recovered LVEF; (3) 42% of patients with recovered LVEF at last evaluation had experienced arrhythmic recurrences during the follow-up and

Author’ Contribution

All persons who meet authorship criteria are listed as authors, and all authors certify that they have participated sufficiently in the work to take public responsibility for the content, including participation in the concept, design, analysis, writing, or revision of the manuscript. Furthermore, each author certifies that this material or similar material has not been and will not be submitted to or published in any other publication before its appearance in the Hong Kong Journal of

Disclosures

Denise Zaffalon's reports were provided by Azienda Sanitaria Universitaria Giuliano-Isontina. Denise Zaffalon reports a relationship with Azienda Sanitaria Integrata Giuliano-Isontina that includes: nonfinancial support. Denise Zaffalon has patent pending to Not available. None.

Acknowledgment

This paper is dedicated to the memory of Professor Fulvio Camerini, foremost expert in cardiomyopathies, outstanding clinician and scientist. We would like to thank Fondazione CRTrieste, and FINCANTIERI for their support. We are also grateful to all the healthcare professionals for the continuous support to research and clinical management of patients and families with CMPs followed in the HF Outpatient Clinic and CMPs Center of Trieste.

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Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-profit sectors.

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