Prevalence of arrhythmia-induced cardiomyopathy: A systematic review and meta-analysis.

BACKGROUND

Arrhythmia-induced cardiomyopathy (AiCM) is a reversible cause of left ventricular systolic dysfunction (LVSD) that arises from sustained cardiac arrhythmias. Despite its clinical significance, AiCM has traditionally been considered a rare entity, and its prevalence remains unknown.

OBJECTIVE

This study aimed to estimate the prevalence of AiCM across various patient populations, assess the impact of baseline characteristics on AiCM development, and critically evaluate the diagnostic criteria used in clinical studies.

METHODS

A systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, with searches performed in PubMed, MEDLINE, and Embase. Studies were selected based on predefined criteria, and quality was evaluated using the Newcastle-Ottawa scale and the Risk of Bias in Non-randomized Studies of Interventions version 2. Meta-regression was used to analyze the factors influencing AiCM prevalence.

RESULTS

From 1149 abstracts, 26 studies involving 7331 patients (mean age 58 years; 26% women; mean left ventricular ejection fraction 46%) were included. The overall prevalence of AiCM was 8%, with a significantly higher prevalence (59%) observed in cohorts of patients with LVSD. AiCM prevalence varied across studies depending on the type of arrhythmia and the diagnostic criteria applied. Multivariable meta-regression identified significant associations between AiCM prevalence and mean left ventricular ejection fraction (odds ratio 0.94; 95% confidence interval 0.90-0.98; P = .002) and patient age (odds ratio 1.15; 95% confidence interval 1.02-1.30; P = .03). Patients with AiCM had consistently higher baseline heart rates than control groups (standardized mean difference random effects model 0.35 [0.09-0.61]; P = .01).

CONCLUSION

AiCM is the most frequent etiology of LVSD in patients with arrhythmias. These findings highlight the need for standardized diagnostic criteria to ensure appropriate management.