Tachycardia-induced cardiomyopathy
ICD-10 I42.9 · ICD-11 BC43.Z

Tachycardia-Induced Cardiomyopathy in Atrial Fibrillation with Decompensated Heart Failure: When Initial Rate Control Has Not Reached Target

Clinical Scenario

This protocol applies to patients with tachycardia-induced cardiomyopathy presenting in the context of atrial fibrillation and decompensated heart failure, where the first-line rate-control approach has not achieved the required heart rate targets.

Previous Treatment — Target Not Reached

Initial management with heart rate-control treatment aimed to achieve a resting heart rate of up to 80 beats/min and up to 115 beats/min during moderate exercise. Failure to reach these targets is the trigger for escalation to the next line.

Why Rate Control Comes First

In decompensated heart failure with atrial fibrillation, initiating with rate control is generally recommended because the recurrence rate of AF following cardioversion is common.

Next-Line Approach (partial)

After rate control and heart failure management, a chemical cardioversion strategy is the structured next step in this clinical scenario. The full sequence, prerequisites, specific agents, and clinical decision criteria are available in the complete protocol.

Instant Access to Structured Evidence-Based Regimens
References

In case of decompensated HF with AF, it is generally recommended to begin with a heart rate-control treatment because recurrence rate of AF following cardioversion is common.

After appropriate rate control, heart failure management and anticoagulation therapy, chemical cardioversion with amiodarone can be performed without a concern for procedure related complications and with a moderate success rate.

DOI: 10.4070/kcj.2019.0199

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