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Research Snapshot Theater: Cardiovascular, Pediatric IV

Arrhythmias and Cardiac Dysfunction: What Drives What?

Tuesday, March 24, 2026
12:30 PM - 1:30 PM Central Time
Location: Connections Central - RST 07

  • Mohamed Radwan, MD (he/him/his)

    Cleveland Clinic Children's Hospital, Ohio

    Disclosure(s): No relevant financial relationship(s) to disclose.

  • RY

    Rozerin Goze Yuksel, MD

    Medical Student
    Marmara University

    Disclosure information not submitted.

  • DT

    Drishti Tolani, MD

    Pediatric Heart Failure and Transplantation Cardiology
    Cleveland Clinic Foundation

    Disclosure information not submitted.

  • NA

    Nir Atlas, MD

    Pediatric Cardiac Critical Care
    Cleveland Clinic Foundation

    Disclosure information not submitted.

  • AP

    Akash Patel, MD

    Pediatric Electrophysiology
    Cleveland Clinic Foundation

    Disclosure information not submitted.

  • PA

    Peter Aziz, MD

    Pediatric Electrophysiology
    Cleveland Clinic Foundation

    Disclosure information not submitted.

  • IE

    Iqbal El-Assaad, MD

    Pediatric Electrophysiology
    Cleveland Clinic Foundation

    Disclosure information not submitted.

Introduction: Tachycardia induced cardiomyopathy (TIC) is a reversible form of heart failure caused by persistent tachyarrhythmia, with recovery after rhythm control. Differentiating TIC from a primary cardiomyopathy with secondary arrhythmias is challenging. We present a 13-year-old male in cardiogenic shock later diagnosed with TIC to illustrate this dilemma.


Description: A previously healthy adolescent presented with one day of dyspnea following a week of URI symptoms. He was tachycardiac to 180 bpm; ECG showed negative inverted P waves in inferior leads ruling out sinus tachycardia. He was tachypneic to the 30s, with normal blood pressure and oxygen saturation. Chest X-ray showed left lower lobe consolidation and bilateral trace pleural effusions, but no cardiomegaly. Inflammatory markers were negative; high sensitivity Troponin T was mildly elevated at 16 ng/L. Respiratory viral panel was positive for Rhino/Enterovirus. Echocardiogram showed a mildly dilated left ventricle with severely depressed function (EF 20%) with concern for viral myocarditis vs. TIC. Treatment included IV milrinone, Lasix, high dose steroids and IVIG without improvement. He was electively cannulated to VA-ECMO. IV amiodarone was initiated after EP consultation. Hours later, his tachycardia abruptly terminated, revealing a sinus rhythm in the 80s. Review of prior vitals revealed a resting HR of 122. After rhythm control, he was decannulated in 4 days with improved EF (45%). EP study confirmed a concealed, decremental, adenosine-sensitive accessory pathway (AP) with inducible orthodromic reentrant tachycardia, consistent with permanent junctional reciprocating tachycardia (PJRT). Catheter ablation was successful, and at 2-week follow-up, LV function had normalized.


Discussion: PJRT is an uncommon cause of incessant arrythmia in adolescents. It is facilitated by a slow-conducting AP leading to a persistent tachycardia that may remain unnoticed until cardiac decompensation occurs. Our patient presented older (13 vs. mean 5.5 years) and recovered faster (24 vs. 93 days). We hypothesize that viral illness and catecholamine surge acutely accelerated his arrhythmia, precipitating cardiogenic shock. This case highlights the impact of unrecognized atrial tachyarrhythmias and the reversibility of TIC with appropriate management.