Atrial Fibrillation in Apparently Idiopathic Cardiomyopathy: The Chicken or the Egg?

  • F. Morady
Conference paper


In 1913, Gossage and Hicks reported the case of a previously healthy 23-year-old man who presented with dyspnea and chest pain and was found, on the basis of radial and jugular pulse tracings, to have atrial fibrillation and a rapid ventricular response [1]. On physical examination, there was no evidence of cardiomegaly. He was treated with tincture of digitalis and continued to have atrial fibrillation, and serial physical examinations demonstrated progressive cardiac enlargement. The patient died suddenly approximately 18 months after first presenting with atrial fibrillation. A postmortem examination demonstrated a dilated and hypertrophied left ventricle, with no valvular lesions and normal coronary arteries. Earlier contemporary studies had suggested that dilatation of the heart may be a common cause of atrial fibrillation, but, based on the findings in their patient, Gossage and Hicks concluded that dilatation of the heart may be caused by, rather than being the cause of, atrial fibrillation [1].


Atrial Fibrillation Dilate Cardiomyopathy Ventricular Pace Ventricular Rate Chronic Atrial Fibrillation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Gossage AM, Hicks BJA (1913) On auricular fibrillation. Q J Med 6:435–640Google Scholar
  2. 2.
    Armstrong PW, Stopps TP, Ford SE, de Bold AJ (1986) Rapid ventricular pacing in the dog: pathophysiologic studies of heart failure. Circulation 74:1075–1084PubMedCrossRefGoogle Scholar
  3. 3.
    Wilson JR, Douglas P, Hickey WF, Lanoce V, Ferraro N, Muhammad A, Reichek N (1987) Experimental congestive heart failure produced by rapid ventricular pacing in the dog: cardiac effects. Circulation 75:857–867PubMedCrossRefGoogle Scholar
  4. 4.
    Chow E, Woodard JC, Farrar DJ (1990) Rapid ventricular pacing in pigs: an experimental model of congestive heart failure. Am J Physiol 258:H1603–H1605PubMedGoogle Scholar
  5. 5.
    Kajstura J, Zhang X, Liu Y, Szoke E, Cheng W, Olivetti G, Hintze TH, Anversa P (1995) The cellular basis of pacing-induced dilated cardiomyopathy: myocyte cell loss and myocyte cellular reactive hypertrophy. Circulation 92:2306–2317PubMedCrossRefGoogle Scholar
  6. 6.
    Damiano RJ, Tripp HF, Asano T, Small KW, Jones RH, Lowe JE (1987) Left ventricular dysfunction and dilatation resulting from chronic supraventricular tachycardia. J Thorac Cardiovasc Surg 94:135–143PubMedGoogle Scholar
  7. 7.
    Spinale FG, Hendrick DA, Crawford FA, Smith AC, Hamada Y, Carabello BA (1990) Chronic supraventricular tachycardia causes ventricular dysfunction and subendocardial injury in swine. Am J Physiol 259:H218–H229PubMedGoogle Scholar
  8. 8.
    Tomita M, Spinale FG, Crawford FA, Zile MR (1991) Changes in left ventricular volume, mass, and function during the development and regression of supraventricular tachycardia-induced cardiomyopathy: disparity between recovery of systolic versus diastolic function. Circulation 83:635–644PubMedCrossRefGoogle Scholar
  9. 9.
    Spinale FG, Fulbright BM, Mukherjee R, Tanaka R, Hu J, Crawford FA, Zile MR (1992) Relation between ventricular and myocyte function with tachycardia-induced cardiomyopathy. Circ Res 71:174–187PubMedCrossRefGoogle Scholar
  10. 10.
    Shinbane JS, Wood MA, Jensen DN, Ellenbogen KA, Fitzpatrick AP, Scheinman MM (1997) Tachycardia-induced cardiomyopathy: a review of animal models and clinical studies. J Am Coll Cardiol 29:709–715PubMedCrossRefGoogle Scholar
  11. 11.
    Daoud EG, Weiss R, Bahu M, Knight BP, Bogun F, Goyal R, Harvey M, Strickberger SA, Man KC, Morady F (1996) Effect of an irregular ventricular rhythm on cardiac output. Am J Cardiol 78:1433–1436PubMedCrossRefGoogle Scholar
  12. 12.
    Natale A, Zimerman L, Tomassoni G, Kearney M, Kent V, Brandon MJ, Newby K (1996) Impact on ventricular function and quality of life of transcatheter ablation of the atrioventricular junction in chronic atrial fibrillation with a normal ventricular response. Am J Cardiol 78:1431–1433PubMedCrossRefGoogle Scholar
  13. 13.
    Phillips E, Levine SA (1949) Auricular fibrillation without other evidence of heart disease. Am J Med 7:478–489PubMedCrossRefGoogle Scholar
  14. 14.
    Peters KG, Kienzle MG (1988) Severe cardiomyopathy due to chronic rapidly conducted atrial fibrillation: complete recovery after restoration of sinus rhythm. Am J Med 85:242–244PubMedCrossRefGoogle Scholar
  15. 15.
    Sacrez A, Kieny JR, Bouheur JB, Komajda M, Bareiss P, Bouilland H, Ferriere M (1990) Effet de la réduction de la fibrillation auriculaire sur la fonction ventriculaire gauche des cardiomyopathies dilatées. Arch Mal Coeur 83:15–21PubMedGoogle Scholar
  16. 16.
    Grogan M, Smith HC, Gersh BJ, Wood DL (1992) Left ventricular dysfunction due to atrial fibrillation in patients initially believed to have idiopathic dilated cardiomyopathy. Am J Cardiol 69:1570–1575PubMedCrossRefGoogle Scholar
  17. 17.
    Kieny JR, Sacrez A, Facello A, Arbogast R, Bareiss P, Roul G, Demangeat JL, Brunot B, Constantinesco A (1992) Increase in radionuclide left ventricular ejection fraction after cardioversion of chronic atrial fibrillation in idiopathic dilated cardiomyopathy. Eur Heart J 13:1290–1295PubMedGoogle Scholar
  18. 18.
    Lemery R, Brugada P, Chriex E, Wellens HJJ (1987) Reversibility of tachycardia-induced left ventricular dysfunction after closed-chest catheter ablation of the atrioventricular junction for intractable atrial fibrillation. Am J Cardiol 60:1406–1408PubMedCrossRefGoogle Scholar
  19. 19.
    Rosenqvist M, Lee MA, Moulinier L, Springer MJ, Abbott JA, Wu J, Langberg JJ, Griffin JC, Scheinman MM (1990) Long-term follow-up of patients after transcatheter direct current ablation of the atrioventricular junction. J Am Coll Cardiol 16:1467–1474CrossRefGoogle Scholar
  20. 20.
    Heinz G, Siostrzonek P, Kreiner G, Gossinger H (1992) Improvement in left ventricular systolic function after successful radiofrequency His bundle ablation for drug refractory, chronic atrial fibrillation and recurrent atrial flutter. Am J Cardiol 69:489–492PubMedCrossRefGoogle Scholar
  21. 21.
    Rodriguez LM, Smeets JLRM, Xie B, de Chillou C, Cheriex E, Pieters F, Metzger J, den Dulk K, Wellens HJJ (1993) Improvement in left ventricular function by ablation of atrioventricular nodal conduction in selected patients with lone atrial fibrillation. Am J Cardiol 72:1137–1141PubMedCrossRefGoogle Scholar
  22. 22.
    Brignole M, Gianfranchi L, Menozzi C, Bottom N, Bollini R, Lolli G, Oddone D, Gaggioli G (1994) Influence of atrioventricular junction radiofrequency ablation in patients with chronic atrial fibrillation and flutter on quality of life and cardiac performance. Am J Cardiol 74:242–246PubMedCrossRefGoogle Scholar
  23. 23.
    Morady F, Hasse C, Strickberger SA, Man KC, Daoud E, Bogun F, Goyal R, Harvey M, Knight BP, Weiss R, Bahu M (1997) Long-term follow-up after radiofrequency modification of the atrioventricular node in patients with atrial fibrillation. J Am Coll Cardiol 27:113–121CrossRefGoogle Scholar
  24. 24.
    Brignole M, Menozzi C, Gianfranchi L, Musso G, Mureddu R, Bottom N, Lolli G (1998) Assessment of atrioventricular junction ablation and VVIR pacemaker versus pharmacological treatment in patients with heart failure and chronic atrial fibrillation. Circulation 98:953–960PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2000

Authors and Affiliations

  • F. Morady
    • 1
  1. 1.Department of Internal Medicine, Division of CardiologyUniversity of MichiganAnn ArborUSA

Personalised recommendations