Arrhythmia-induced cardiomyopathy: a 12-year follow-up of a patient with atrial fibrillation (case report)

Arrhythmia-induced cardiomyopathy (AiCM) is a reversible complication of atrial fibrillation/flutter, but its diagnosis and optimal management remain challenging clinical issues. Long-term follow-up of patients with AiCM is of particular interest for assessing long-term outcomes and improving management strategies. This article describes a case of a 50-year-old female patient with an aggressive onset of tachystolic atrial fibrillation. This led to severe left ventricular dysfunction, arrhythmogenic shock, and life-threatening complications, including pulmonary embolism and ischemic stroke, despite optimal antithrombotic therapy. Initially, despite pharmacotherapy and multiple electrical cardioversions, stable sinus rhythm could not be achieved. A triple chamber cardioverter-defibrillator was implanted with the expected subsequent atrioventricular junction destruction. However, following rhythmcontrol strategy was further selected: a series of catheter ablations (pulmonary vein isolation and atrial substrate modification) were performed, which restored and maintained sinus rhythm. This resulted in complete normalization of left ventricular function and heart failure compensation over a 10-year period. Ten years after the last ablation, a late arrhythmia recurrence was noted, requiring repeat surgery. This case demonstrates the effectiveness of an active, including multi-stage, rhythm control strategy for AiCM, which can lead to complete and long-term restoration of cardiac function. Key aspects of management include early and aggressive arrhythmia termination, readiness to adjust the strategy, awareness of the risk of late recurrences due to progressive atrial remodeling, and the need for lifelong follow-up.