Clinical management and prognosis of tachycardia-induced cardiomyopathy in children: a retrospective cohort study with 15-year single-center experience

Abstract

We described the clinical features and prognosis of pediatric tachycardia-induced cardiomyopathy (TIC). We retrospectively reviewed the data of children with TIC at a tertiary children’s hospital in China between 2009 and 2024. Overall, 101 children (58 boys) were included, with a median age at TIC diagnosis of 1.4 years (0.3, 7.0). Focal atrial tachycardia (FAT) was the most common cause (55.4%). Ablation-related adverse events were more common in children ≤ 1 year (66.7%, 2/3) than in those > 1 year (8.7%, 4/46; P =0.04 ). Age at TIC onset (hazard ratio [HR]: 0.912 per 1-year increase; 95% confidence interval [CI]: 0.863–0.964; P = 0.001), incessant tachycardia (HR: 0.480, 95% CI: 0.310–0.743; P < 0.001), and baseline left ventricular end-diastolic dimension Z-score (HR: 0.828 per 1 SD increase, 95% CI: 0.700–0.980; P = 0.028) were independent predictors of LVEF recovery. At final follow-up (median: 34.0 [14.0–67.0] months), tachyarrhythmia had resolution spontaneously in 46 patients (45.5%). Age ≤ 1 year old is associated with 8.309-fold greater odds of spontaneous resolution. Pediatric tachycardia-induced cardiomyopathy is mainly caused by focal atrial tachycardia. Most children recover fully after rhythm control. Older age, incessant tachycardia, and larger LV dilation predict slower recovery, while infants show higher spontaneous resolution but greater ablation risk.