The impact of Total Management for Heart Failure: A Case of Tachycardia Induced Cardiomyopathy

A 38 years-old man was referred to our hospital for further cardiac examination of atrial tachycardia and poor left ventricular (LV) function. ECG showed atrial fibrillation (AF) tachycardia (130 beats/min), transthoracic echocardiography revealed LV dilation, diffuse hypokinesis (LVEF 35%) and no significant valvular heart disease. He had diagnosed as a tachycardia-induced cardiomyopathy, because he had no significant coronary stenosis and structural heart disease. After administration, he recovered sinus rhythm by DC shock and maintained with amiodarone administration. In addition, sleep study reveled mild sleep apnea syndrome. Therefore, adaptive servo-ventilation therapy had also performed. Optimal medical therapy (OMT), including angiotensin converting enzyme inhibitors and β blockers, and non-pharmacological treatments were started. Three months after first administration, LVEF and BNP were dramatically improved, from 35 to 49%, and from 752 to 16 pg/ml, respectively. However, He had sometimes palpitations and Holter ECG showed paroxysmal AF recurrence with short duration. Therefore, pulmonary vein (PV) isolation by radiofrequency catheter ablation was performed. Four years after PV isolation, he had never administration for heart failure worsening and AF recurrence. In conclusion, total management is very important for heart failure patients. In especially, OMT and catheter ablation are useful and safety treatment for patients with tachycardia-induced cardiomyopathy.