TY - JOUR
T1 - Predictors of myocardial recovery in pediatric tachycardia-induced cardiomyopathy
AU - Moore, Jeremy P.
AU - Patel, Payal A.
AU - Shannon, Kevin M.
AU - Albers, Erin L.
AU - Salerno, Jack C.
AU - Stein, Maya A.
AU - Stephenson, Elizabeth A.
AU - Mohan, Shaun
AU - Shah, Maully J.
AU - Asakai, Hiroko
AU - Pflaumer, Andreas
AU - Czosek, Richard J.
AU - Everitt, Melanie D.
AU - Garnreiter, Jason M.
AU - McCanta, Anthony C.
AU - Papez, Andrew L.
AU - Escudero, Carolina
AU - Sanatani, Shubhayan
AU - Cain, Nicole B.
AU - Kannankeril, Prince J.
AU - Bratincsak, Andras
AU - Mandapati, Ravi
AU - Silva, Jennifer N.A.
AU - Knecht, Kenneth R.
AU - Balaji, Seshadri
N1 - Published by Elsevier Inc.
PY - 2014/7
Y1 - 2014/7
N2 - BACKGROUND: Tachycardia-induced cardiomyopathy (TIC) carries significant risk of morbidity and mortality, although full recovery is possible. Little is known about the myocardial recovery pattern.OBJECTIVE: The purpose of this study was to determine the time course and predictors of myocardial recovery in pediatric TIC.METHODS: An international multicenter study of pediatric TIC was conducted. Children ≤18 years with incessant tachyarrhythmia, cardiac dysfunction (left ventricular ejection fraction [LVEF] <50%), and left ventricular (LV) dilation (left ventricular end-diastolic dimension [LVEDD] z-score ≥2) were included. Children with congenital heart disease or suspected primary cardiomyopathy were excluded. Primary end-points were time to LV systolic functional recovery (LVEF ≥55%) and normal LV size (LVEDD z-score <2).RESULTS: Eighty-one children from 17 centers met inclusion criteria: median age 4.0 years (range 0.0-17.5 years) and baseline LVEF 28% (interquartile range 19-39). The most common arrhythmias were ectopic atrial tachycardia (59%), permanent junctional reciprocating tachycardia (23%), and ventricular tachycardia (7%). Thirteen required extracorporeal membrane oxygenation (n = 11) or ventricular assist device (n = 2) support. Median time to recovery was 51 days for LVEF and 71 days for LVEDD. Two (4%) underwent heart transplantation, and 1 died (1%). Multivariate predictors of LV systolic functional recovery were age (hazard ratio [HR] 0.61, P = .040), standardized tachycardia rate (HR 1.16, P = .015), mechanical circulatory support (HR 2.61, P = .044), and LVEF (HR 1.33 per 10% increase, p=0.005). For normalization of LV size, only baseline LVEDD (HR 0.86, P = .008) was predictive.CONCLUSION: Pediatric TIC resolves in a predictable fashion. Factors associated with faster recovery include younger age, higher presenting heart rate, use of mechanical circulatory support, and higher LVEF, whereas only smaller baseline LV size predicts reverse remodeling. This knowledge may be useful for clinical evaluation and follow-up of affected children.
AB - BACKGROUND: Tachycardia-induced cardiomyopathy (TIC) carries significant risk of morbidity and mortality, although full recovery is possible. Little is known about the myocardial recovery pattern.OBJECTIVE: The purpose of this study was to determine the time course and predictors of myocardial recovery in pediatric TIC.METHODS: An international multicenter study of pediatric TIC was conducted. Children ≤18 years with incessant tachyarrhythmia, cardiac dysfunction (left ventricular ejection fraction [LVEF] <50%), and left ventricular (LV) dilation (left ventricular end-diastolic dimension [LVEDD] z-score ≥2) were included. Children with congenital heart disease or suspected primary cardiomyopathy were excluded. Primary end-points were time to LV systolic functional recovery (LVEF ≥55%) and normal LV size (LVEDD z-score <2).RESULTS: Eighty-one children from 17 centers met inclusion criteria: median age 4.0 years (range 0.0-17.5 years) and baseline LVEF 28% (interquartile range 19-39). The most common arrhythmias were ectopic atrial tachycardia (59%), permanent junctional reciprocating tachycardia (23%), and ventricular tachycardia (7%). Thirteen required extracorporeal membrane oxygenation (n = 11) or ventricular assist device (n = 2) support. Median time to recovery was 51 days for LVEF and 71 days for LVEDD. Two (4%) underwent heart transplantation, and 1 died (1%). Multivariate predictors of LV systolic functional recovery were age (hazard ratio [HR] 0.61, P = .040), standardized tachycardia rate (HR 1.16, P = .015), mechanical circulatory support (HR 2.61, P = .044), and LVEF (HR 1.33 per 10% increase, p=0.005). For normalization of LV size, only baseline LVEDD (HR 0.86, P = .008) was predictive.CONCLUSION: Pediatric TIC resolves in a predictable fashion. Factors associated with faster recovery include younger age, higher presenting heart rate, use of mechanical circulatory support, and higher LVEF, whereas only smaller baseline LV size predicts reverse remodeling. This knowledge may be useful for clinical evaluation and follow-up of affected children.
KW - Antiarrhythmic drugs
KW - Cardiomyopathy
KW - Catheter ablation
KW - Supraventricular tachycardia
KW - Ventricular remodeling
KW - Cardiomyopathies/etiology
KW - Prognosis
KW - Ventricular Function, Left/physiology
KW - Follow-Up Studies
KW - Heart Ventricles/physiopathology
KW - Humans
KW - Child, Preschool
KW - Tachycardia/physiopathology
KW - Infant
KW - Male
KW - Treatment Outcome
KW - Adolescent
KW - Myocardium
KW - Female
KW - Child
UR - https://www.scopus.com/pages/publications/84903162082
UR - https://www.scopus.com/pages/publications/84903162082#tab=citedBy
U2 - 10.1016/j.hrthm.2014.04.023
DO - 10.1016/j.hrthm.2014.04.023
M3 - Article
C2 - 24751393
SN - 1547-5271
VL - 11
SP - 1163
EP - 1169
JO - Heart Rhythm
JF - Heart Rhythm
IS - 7
ER -