Tachycardia induced cardiomyopathy as a hidden cause of Heart failure in Pediatrics; A retrospective single-centre study

Introduction: Heart failure in pediatrics represents a clinical challenge that requires a comprehensive approach. Early diagnosis and multidisciplinary management are crucial to improve prognosis in such cases. Understanding the unique aspects of HF in pediatrics is essential for effective treatment and care. Unfortunately, a great proportion of pediatric dilated cardiomyopathy cases are classified as idiopathic. Therefore, there is an increasing need to find out the possible hidden causes for cardiomyopathy. Methods: We retrospectively analyzed our pediatric electrophysiology clinic data since 2019 until 2024. Among our patients,12 pediatric patients diagnosed with tachycardia-Induced cardiomyopathy were included in our study. We analyzed their baseline clinical, electrocardiographic, and cardiac imaging characteristics, management plans as well as their outcomes during follow up visits. Results: Study population had a mean age of 9 year with 85% of them, had NYHA III heart failure symptoms at the initial presentations. Average duration of tachycardia is 16 month, and mean heart rate of 140 bpm. Incessant atrial arrythmia was the most common presenting arrythmia (54%) followed by PVCs and AV reentrant tachycardia. Mean LVEF was 35% at time of diagnosis. Ablation was the mainstay of management plan of 11 patients with radiofrequency ablation as the standard modality guided with 3D-electro-anatomical mapping. One patient required cryoablation for right atrial appendage isolation. Recovery of ventricular function was achieved in all ablation cohort with no recurrence of arrythmia along follow up. Conclusions: We highlight TIC as an important underdiagnosed cause for heart failure in pediatrics via our center experience in such cases.