Predictors of myocardial recovery in pediatric tachycardia-induced cardiomyopathy

Jeremy P. Moore, Payal A. Patel, Kevin M. Shannon, Erin L. Albers, Jack C. Salerno, Maya A. Stein, Elizabeth A. Stephenson, Shaun Mohan, Maully J. Shah, Hiroko Asakai, Andreas Pflaumer, Richard J. Czosek, Melanie D. Everitt, Jason M. Garnreiter, Anthony C. McCanta, Andrew L. Papez, Carolina Escudero, Shubhayan Sanatani, Nicole B. Cain, Prince J. KannankerilAndras Bratincsak, Ravi Mandapati, Jennifer N.A. Silva, Kenneth R. Knecht, Seshadri Balaji

Research output: Contribution to journalArticle

28 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1163-1169
Number of pages7
JournalHeart Rhythm
Volume11
Issue number7
DOIs
StatePublished - Jul 2014

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Keywords

  • Antiarrhythmic drugs
  • Cardiomyopathy
  • Catheter ablation
  • Supraventricular tachycardia
  • Ventricular remodeling

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Moore, J. P., Patel, P. A., Shannon, K. M., Albers, E. L., Salerno, J. C., Stein, M. A., Stephenson, E. A., Mohan, S., Shah, M. J., Asakai, H., Pflaumer, A., Czosek, R. J., Everitt, M. D., Garnreiter, J. M., McCanta, A. C., Papez, A. L., Escudero, C., Sanatani, S., Cain, N. B., ... Balaji, S. (2014). Predictors of myocardial recovery in pediatric tachycardia-induced cardiomyopathy. Heart Rhythm, 11(7), 1163-1169. https://doi.org/10.1016/j.hrthm.2014.04.023