Reversible left ventricular dysfunction secondary to rapid atrial fibrillation

Kanji Iga MD, *Shuichi Takahashi MT, *Muneto Yamashita MT, Kenjiro Hori MD, Tadashi Matsumura MD, Hiromitsu Gen MD

Summary

We present 4 patients of reversible left ventricular dysfunction associated with severe congestive heart failure presumably induced by rapid atrial fibrillation. The mean heart rate was 159 beats/min. and the mean left ventricular end-diastolic dimension was 58.5 mm with diffusely impaired left ventricular motion. None of the patients had a history of preceding upper respiratory infection before the acute episode and no signs of inflammation at onset, and all patients were New York York Heart Association Class I or II before the acute episode. Left ventriculography, done about one month when congestive heart failure and ventricular rate were controlled with digitalis and diuretics, still showed diffusely decreased left ventricular motion; the mean end-diastolic volume was 165 ml and the mean ejection fraction was 30 %. Coronary angiography was normal in 3 patients and one showed moderate left anterior descending artery stenosis. Right ventricular biopsy, done in 3 patients showed no evidence of myocarditis. Left ventricular wall motion normalized in 5-36 months on follow-up echocardiography. These findings suggest that persistent rapid atrial fibrillation can cause reversible left ventricular dysfunction which can take a considerable period of time to normalize.