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First reported case of recurrent tachycardia-induced cardiomyopathy due to atrial flutter.

The patient is a 61-year-old Caucasian male with a history of hypertension and hyperlipidemia who presented in 2010 with 3 days of progressively worsening palpitations, chest tightness and shortness of breath. There was no history of paroxysmal nocturnal dyspnea, orthopnea or syncope. The remainder of the review of symptoms was unremarkable. There is no family history of premature sudden death. His medications were Aspirin, Metoprolol succinate, Lisinopril, Amlodipine and Atorvastatin.

He first presented with an arrhythmia in 2007 with a 3-day history of palpitations and light-headedness and he was diagnosed with atrial flutter with 2:1 heart block and a heart rate of 150 beats/min. Transesophageal echocardiography (TEE) revealed normal left ventricular (LV) size with moderately decreased LV systolic function, global hypokinesia and an ejection fraction (EF) of 35% (Fig. 1). There was no left atrial thrombus, hence, he received direct current cardioversion (DCCV) and was converted back to sinus rhythm. His baseline laboratories including thyroid function tests were within normal limits. The follow-up echocardiogram 2 months later revealed normal LV size and systolic function. He was therefore felt to have a resolved Tachycardia-Induced Cardiomyopathy (TIC) at that time and was treated with beta-blockers and aspirin after 1 month of warfarin. 



Figure 1. 
EF at presentation of each episode of tachyarrhythmia at 0, 10th and 40th month and subsequent recovery of EF after correction of each episode in 2nd, 14th and 42nd months, respectively.



He had another episode of sustained …