Transient Ventricular Dysfunction after Tachycardia-induced Cardiomyopathy: Implications for Timing of Rhythm Control and Device Therapy

Abstract

Tachycardia-induced cardiomyopathy (TIC) is a reversible form of ventricular dysfunction resulting from sustained or recurrent tachyarrhythmias, often presenting as dilated cardiomyopathy with reduced left ventricular ejection fraction. This study provides a narrative synthesis of current evidence on the recovery of ventricular function following rhythm control and its implications for the timing of device therapy. A comprehensive review of published literature was conducted, focusing on pathophysiology, clinical outcomes, and management strategies in TIC. The findings consistently demonstrate that effective control of the underlying arrhythmia, particularly through early rhythm control or catheter ablation, leads to significant improvement or normalisation of ventricular function in most patients. Recovery may begin within weeks but often requires several months for full restoration, depending on the duration and severity of tachycardia. However, a subset of patients may experience incomplete recovery due to irreversible myocardial remodelling or underlying structural heart disease. Recurrence of tachyarrhythmias is associated with rapid deterioration of ventricular function, highlighting the importance of sustained rhythm control. Importantly, the transient nature of ventricular dysfunction in TIC has significant implications for device therapy, as early implantation of implantable cardioverter-defibrillators or cardiac resynchronisation therapy may be unnecessary in many cases. A strategy of deferring device therapy until reassessment after rhythm control is therefore recommended. In conclusion, early recognition and timely rhythm management are critical to optimising outcomes in TIC, while individualised decision-making is essential to avoid unnecessary interventions.