Arrhythmia-induced cardiomyopathy (AIC) is defined as impaired left ventricular function due to cardiac arrhythmias. We sought to investigate the association between coronary microvascular dysfunction (CMD) and AIC in patients with atrial fibrillation (AF).

Methods

In this multicenter observational study, we enrolled consecutive patients with recent diagnosis of AF (<6 months) who underwent invasive coronary physiology assessment with the bolus thermodilution technique. Patients were divided into two groups according to left ventricular ejection fraction (LVEF): AIC group if LVEF < 50% and preserved LVEF group if LVEF ≥ 50%. A third group of patients with a recent diagnosis of dilated cardiomyopathy (DCM) and without AF was analyzed as control group. CMD was defined as abnormal coronary flow reserve (CFR < 2.5) and/or abnormal index of microcirculatory resistance (IMR ≥ 25).

Results

Among 84 analyzed patients, 33 were in the AIC group, 39 in the preserved LVEF group, and 12 in the DCM group. CMD was more frequently detected in the AIC group compared to the preserved LVEF (79% vs. 38%, p < 0.001) and DCM groups (79% vs. 33%, p = 0.01). In patients with AF, a significant correlation was found between CFR and LVEF (beta coefficient: 3.8; 95% CI: 1.8−5.9; p < 0.001), and IMR and LVEF (beta coefficient: −0.3; 95% CI: −0.4 to −0.1; p = 0.001). At multivariable analysis, CMD was independently associated with AIC (adjusted odds ratio: 6.2; 95% CI: 2.2 to 20.1; p = 0.001).

Conclusions

CMD is strongly and independently associated with the degree of left ventricular dysfunction and may play a role in the development of AIC in patients with AF.

Conflicts of Interest

The authors declare no conflicts of interest.

Open Research

Data Availability Statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

References

1C. A. Martin and P. D. Lambiase, “Pathophysiology, Diagnosis and Treatment of Tachycardiomyopathy,” Heart 103 (2017): 1543–1552.
10.1136/heartjnl-2016-310391
PubMed Web of Science® Google Scholar
2A. M. Gossage and H. I. C. K. S. Jab, “On Auricular Fibrillation,” QJM: An International Journal of Medicine os6 (1913): 435–440.
Google Scholar
3J. S. Shinbane, M. A. Wood, D. N. Jensen, K. A. Ellenbogen, A. P. Fitzpatrick, and M. M. Scheinman, “Tachycardia-Induced Cardiomyopathy: A Review of Animal Models and Clinical Studies,” Journal of the American College of Cardiology 29 (1997): 709–715.
10.1016/S0735-1097(96)00592-X
CAS PubMed Web of Science® Google Scholar
4B. Bozkurt, M. Colvin, J. Cook, et al., “Current Diagnostic and Treatment Strategies for Specific Dilated Cardiomyopathies: A Scientific Statement From the American Heart Association,” Circulation 134 (2016): e579–e646, https://doi.org/10.1161/CIR.0000000000000455.
10.1161/CIR.0000000000000455
PubMed Web of Science® Google Scholar
5P. J. Gentlesk, W. H. Sauer, E. P. Gerstenfeld, et al., “Reversal of Left Ventricular Dysfunction Following Ablation of Atrial Fibrillation,” Journal of Cardiovascular Electrophysiology 18 (2007): 9–14.
10.1111/j.1540-8167.2006.00653.x
PubMed Web of Science® Google Scholar
6P. Shoureshi, A. Y. Tan, J. Koneru, K. A. Ellenbogen, K. Kaszala, and J. F. Huizar, “Arrhythmia-Induced Cardiomyopathy,” Journal of the American College of Cardiology 83 (2024): 2214–2232.
10.1016/j.jacc.2024.03.416
CAS PubMed Web of Science® Google Scholar
7F. Crea, R. A. Montone, and R. Rinaldi, “Pathophysiology of Coronary Microvascular Dysfunction,” Circulation Journal 86 (2022): 1319–1328.
10.1253/circj.CJ-21-0848
CAS PubMed Web of Science® Google Scholar
8E. I. Skalidis, M. I. Hamilos, I. K. Karalis, G. Chlouverakis, G. E. Kochiadakis, and P. E. Vardas, “Isolated Atrial Microvascular Dysfunction in Patients With Lone Recurrent Atrial Fibrillation,” Journal of the American College of Cardiology 51 (2008): 2053–2057.
10.1016/j.jacc.2008.01.055
PubMed Web of Science® Google Scholar
9R. S. Wijesurendra, A. Liu, F. Notaristefano, et al., “Myocardial Perfusion Is Impaired and Relates to Cardiac Dysfunction in Patients With Atrial Fibrillation Both Before and After Successful Catheter Ablation,” Journal of the American Heart Association 7 (2018): e009218.
10.1161/JAHA.118.009218
CAS PubMed Web of Science® Google Scholar
10N. H. J. Pijls, B. De Bruyne, L. Smith, et al., “Coronary Thermodilution to Assess Flow Reserve: Validation in Humans,” Circulation 105 (2002): 2482–2486.
10.1161/01.CIR.0000017199.09457.3D
PubMed Web of Science® Google Scholar
11W. F. Fearon, L. B. Balsam, H. M. O. Farouque, et al., “Novel Index for Invasively Assessing the Coronary Microcirculation,” Circulation 107 (2003): 3129–3132.
10.1161/01.CIR.0000080700.98607.D1
PubMed Web of Science® Google Scholar
12M. Kodeboina, S. Nagumo, D. Munhoz, et al., “Simplified Assessment of the Index of Microvascular Resistance,” Journal of Interventional Cardiology 2021 (2021): 1–7.
10.1155/2021/9971874
Web of Science® Google Scholar
13O. M. Demir, C. K. M. Boerhout, G. A. de Waard, et al., “Comparison of Doppler Flow Velocity and Thermodilution Derived Indexes of Coronary Physiology,” JACC: Cardiovascular Interventions 15 (2022): 1060–1070.
10.1016/j.jcin.2022.03.015
PubMed Web of Science® Google Scholar
14T. Bringmans, A. Benedetti, C. Zivelonghi, et al., “The Belgian Registry on Coronary Function Testing (BELmicro Registry): Study Population, Prevalence of Coronary Vascular Dysfunction, and Procedural Safety,” American Journal of Cardiology 231 (2024): 32–39.
10.1016/j.amjcard.2024.08.035
CAS PubMed Web of Science® Google Scholar
15A. F. M. Van Den Heuvel, D. J. Van Veldhuisen, E. E. Van Der Wall, et al., “Regional Myocardial Blood Flow Reserve Impairment and Metabolic Changes Suggesting Myocardial Ischemia in Patients With Idiopathic Dilated Cardiomyopathy,” Journal of the American College of Cardiology 35 (2000): 19–28.
10.1016/S0735-1097(99)00499-4
CAS PubMed Web of Science® Google Scholar
16A. Gulati, T. F. Ismail, A. Ali, et al., “Microvascular Dysfunction in Dilated Cardiomyopathy,” JACC: Cardiovascular Imaging 12 (2019): 1699–1708.
10.1016/j.jcmg.2018.10.032
PubMed Web of Science® Google Scholar
17M. Vanderheyden, J. Bartunek, S. Verstreken, L. Mortier, M. Goethals, and B. Debruyne, “Non-Invasive Assessment of Coronary Flow Reserve in Idiopathic Dilated Cardiomyopathy: Hemodynamic Correlations,” European Journal of Echocardiography 6 (2005): 47–53.
10.1016/j.euje.2004.06.006
PubMed Google Scholar
18E. I. Skalidis, F. I. Parthenakis, A. P. Patrianakos, M. I. Hamilos, and P. E. Vardas, “Regional Coronary Flow and Contractile Reserve in Patients with Idiopathic Dilated Cardiomyopathy,” Journal of the American College of Cardiology 44 (2004): 2027–2032.
10.1016/j.jacc.2004.08.051
PubMed Web of Science® Google Scholar
19M. Canetti, M. W. Akhter, A. Lerman, et al., “Evaluation of Myocardial Blood Flow Reserve in Patients With Chronic Congestive Heart Failure Due to Idiopathic Dilated Cardiomyopathy,” American Journal of Cardiology 92 (2003): 1246–1249.
10.1016/j.amjcard.2003.08.002
PubMed Web of Science® Google Scholar
20S. Roura and A. Bayes-Genis, “Vascular Dysfunction in Idiopathic Dilated Cardiomyopathy,” Nature Reviews Cardiology 6 (2009): 590–598.
10.1038/nrcardio.2009.130
PubMed Web of Science® Google Scholar

Volume106, Issue1

July 1, 2025

Pages 317-324

SCAI Member Sign in

Invasive Coronary Physiology Assessment in Patients With Arrhythmia-Induced Cardiomyopathy

ABSTRACT

Background

Methods

Results

Conclusions

Conflicts of Interest

Open Research

Data Availability Statement

References

References

Information

About Wiley Online Library

Help & Support

Opportunities

Connect with Wiley

Invasive Coronary Physiology Assessment in Patients With Arrhythmia-Induced Cardiomyopathy

ABSTRACT

Background

Methods

Results

Conclusions

Conflicts of Interest

Open Research

Data Availability Statement

References

References

Related

Information