tachy cardiomyopathy - recover?

Hia,

I had persistant artial tachycardia which caused DCM, diagnosed 15 months ago and presented itself with major heart failure and odema. As usual it went undiagnosed for many months but eventually 4 months ago I had an RF ablation to control the Tachy and the heart seems to now be reducing in size, although it's early days to know if this will continue.

a) Can I ask though is Atrial Tachycardia the same as A Fib?

b) Also does the 5 year prognosis for heart failure mortality apply to those whose hearts have returned to normal size (or an improved EF)?

c) I find it hard to believe that my heart could have gone through so much (mitral valve leakage aswell) and yet return to 'normal' but are there patients that have recovered from DCM (ef was 20% max) and gone on to lead a normal length life?  - there does not seem to be any data of patients surviving a recovered DCM longterm!

d) What is the risk of sudden death in damamged hearts, because I find myself not daring to do anything physically exhertive incase I bring on an attack!  If my arrythimia or DCM came back, would I have the same warning as before (ie: heart failure) or would it be likely to now just cause sudden death?

A million thanks!  My Cardio is so evasive when I ask these questions!

Julie.

(julie.***@****)

[CCF-M.D.-RCJ]

Julie,

Sorry to read of your recent troubles.

(a) ATach is an organized atrial rhythm with a rate greater than 100 beats/minute. Afib is not organized and is generally seen after long-standing high blood pressure or atrial distention.  The rate of afib is faster as well -- usually more than 300 bpm.

(b) The 5 year mortality most certainly does not apply to patients whose CHF has resolved.

(c) If your heart returns back to its former size and function, you should have a normal life expectancy. A review of the limited literature reveals that the longer one has a tachycardia-induced cardiomyopathy, the lower the chance of a full recovery.  Good  studies are lacking, however.

(d) In general, the more permanent damage done to a heart, the higher the incidence of sudden death.  As your heart's function improves, your risk will decline.  I would strongly suggest that you enroll in a cardiac rehab progam in your area where you can undergo supervised exercise.  The supervision will allow you to push yourself so that when you're involved in recreation, you can feel safe doing the things you want to do.  As an added bonus, the monitoring provided by rehab should pick up any recurrence of the atrial tach.  It might also be a smart idea to learn to take your pulse -- then you could pick up any abnormality by performing daily or weekly checks.

Any recurrence of the atrial tach would likely again lead to symptoms of heart failure, and not sudden death.

I've provided some references below if you are interested.

Hope that helps.

Shinbane, JS, Wood, MA, Jensen, DN, et al. Tachycardia-induced cardiomyopathy: A review of animal models and clinical studies. J Am Coll Cardiol 1997; 29:709.

Fishberger SB; Colan SD; Saul JP; Mayer JE Jr; Walsh EP. Myocardial mechanics before and after ablation of chronic tachycardia. Pacing Clin Electrophysiol 1996 Jan;19(1):42-9