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Tachycardia-induced Cardiomyopathy — EECC MCQ

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ModerateHeart FailureTachycardia-induced CardiomyopathyEECC

A 55-year-old man with newly diagnosed AF undergoes echocardiography which shows LVEF 35% and LV dilatation. After rate control (HR reduced from 140 to 75 bpm) and 3 months of GDMT, his LVEF recovers to 52%. What was the likely cause of the initial LV dysfunction?

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Correct answer: D — Tachycardia-induced cardiomyopathy (tachymyopathy) — sustained rapid ventricular rates can cause reversible LV dysfunction which recovers after adequate rate or rhythm control

Tachycardia-induced cardiomyopathy (tachymyopathy) is a reversible cause of LV dysfunction resulting from sustained rapid ventricular rates. It can be caused by any tachyarrhythmia (AF, atrial flutter, incessant SVT, high PVC burden). The mechanism involves chronic metabolic depletion, cellular remodelling, and neurohormonal activation from persistent tachycardia. Key features: (1) LV dysfunction temporally related to tachycardia; (2) recovery of LVEF after adequate rate/rhythm control (typically within 1-6 months); (3) absence of other causes of cardiomyopathy. The 2024 ESC AF Guidelines recognise tachymyopathy as an important reversible cause of HF. It must be distinguished from AF occurring as a consequence of pre-existing cardiomyopathy — in tachymyopathy, the arrhythmia is the cause, not the consequence.

Reference: ESC (2024): AF Guidelines; ESC (2023): HF Guidelines