Definition and Management of Arrhythmia-induced Cardiomyopathy: Findings from the European Heart Rhythm Association Survey

Background: Arrhythmia-induced Cardiomyopathy (AiCM) represents a subtype of acute heart failure (HF) in the context of sustained arrhythmia. Clear definitions and management recommendations for AiCM are lacking. Purpose: The European Heart Rhythm Association Scientific Initiatives Committee (EHRA SIC) conducted a survey to explore the current definitions and management of patients with AiCM among European and non-European electrophysiologists. Methods: A 25-item online questionnaire was developed and distributed among EP specialists on the EHRA SIC website and on social media between September 4th and October 5th 2023. Results: Of the 206 respondents, 16% were female and 61% were between 30-49 years old. Most of the respondents were EP-Specialists (81%) working at University Hospitals (47%). While most participants (67%) agreed that AiCM should be defined as a left ventricular ejection fraction (LVEF) impairment after new onset of an arrhythmia, only 35% identified a specific LVEF drop to diagnose AiCM with a wide range of values (5-20% LVEF drop). Most respondents considered all available therapies: catheter ablation(93%), electrical cardioversion(83%), antiarrhythmic drugs (76%) and adjuvant HF treatment(76%). 83% of respondents indicated that adjuvant HF treatment should be started at first HF diagnosis prior to antiarrhythmic treatment and 84% agreed it should be stopped within six months after LVEF normalization. Responses for the optimal time point for the first LVEF reassessment during follow-up varied markedly (1 day-6 months after antiarrhythmic treatment). Conclusion: This EHRA Survey reveals varying practices regarding AiCM among physicians, highlighting a lack of consensus and heterogenous care of these patients.