AimsNo study has analyzed the impact of guideline‐directed medical therapy in preventing heart failure (HF) relapse in patients with arrhythmia‐induced cardiomyopathy (AiCM) following left ventricular ejection fraction (LVEF) improvement.Methods and resultsWe analyzed data from a single‐center cohort of 200 patients admitted for HF, LVEF <50% and cardiac arrhythmia considered by cardiologists to be the precipitating cause of the episode. The primary endpoint was time‐to‐HF relapse, defined as the composite of readmission for HF, Emergency Department (ED) visit for HF, or significant decline in LVEF. Changes in medication were recorded and a time‐varying multivariate Cox regression was performed. After a median follow‐up period of 6.14 years, diagnostic confirmation was achieved in 188 out of the initial 200 patients with suspected AiCM. A total of 89 patients (47.3%) met the primary endpoint. RAS inhibitors (adjusted hazard ratio (HR) 0.50 [0.31–0.81]; p = 0.005) and beta‐blockers (adjusted HR 0.48 [0.28–0.81]; p = 0.006) were associated with a lower incidence of relapse. Mineralocorticoid receptor antagonists were associated with a significantly lower incidence of ED visits for HF (adjusted HR 0.38 [0.15–0.95]; p = 0.038), but did not achieve statistical significance for the combined primary endpoint. Antiarrhythmic drugs did not show a significant impact on the primary endpoint.ConclusionMaintaining RAS inhibitors and beta‐blockers was associated with a significantly lower incidence of relapse in the setting of AiCM with improved LVEF.

中文翻译：

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左心室射血分数改善的心律失常诱发的心肌病心力衰竭的指南指导性药物治疗


AimsNo 研究分析了指南指导的药物治疗对预防左心室射血分数 （LVEF） 改善后心律失常诱发的心肌病 （AiCM） 患者心力衰竭 （HF） 复发的影响。方法和结果我们分析了来自 200 名因 HF、LVEF <50% 和心脏病专家认为是发作诱发原因的心律失常患者的单中心队列的数据。主要终点是 HF 复发时间，定义为 HF 再入院、HF 急诊科 （ED） 就诊或 LVEF 显着下降的复合值。记录药物的变化并进行时变多变量 Cox 回归。中位随访期为 6.14 年后，最初的 200 名疑似 AiCM 患者中有 188 名获得诊断确认。共有 89 例患者 （47.3%） 达到主要终点。RAS 抑制剂 （调整后的风险比 （HR） 0.50 [0.31–0.81];p = 0.005） 和 β 受体阻滞剂 （调整后 HR 0.48 [0.28–0.81];p = 0.006） 与较低的复发发生率相关。盐皮质激素受体拮抗剂与 HF 急诊就诊发生率显著降低相关 （校正 HR 0.38 [0.15–0.95];p = 0.038），但未达到联合主要终点的统计学意义。抗心律失常药物对主要终点没有显著影响。结论在 LVEF 改善的 AiCM 患者中，维持 RAS 抑制剂和 β 受体阻滞剂与显著降低复发发生率相关。