Key result
Cautious GDMT, rate control, and cardioversion recover LV systolic function in MELAS cardiomyopathy.
Why the study?
Management of heart failure and arrhythmias in patients with MELAS is challenging due to potential mitochondrial toxicity of conventional medications.
Case Report (n=1)
Conventional heart failure and atrial fibrillation therapies can be effectively used in selected patients with MELAS when managed with multidisciplinary collaboration and cautious titration.
Answers are grounded in this paper and cite their sources.
Supports cautious use of standard HF therapies in MELAS under monitoring; leaves open need for prospective validation.
BACKGROUND: Mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS) is a mitochondrial DNA disorder in which medications that impair mitochondrial function may worsen disease manifestations. Management of heart failure and arrhythmias in this population is therefore challenging. CASE SUMMARY: A 54-year-old woman with MELAS presented with acute hypoxemic respiratory failure, atrial fibrillation with rapid ventricular response, and newly reduced left ventricular ejection fraction. Transesophageal echocardiography demonstrated a left atrial appendage thrombus, precluding immediate cardioversion. In collaboration with medical genetics, rate-control and guideline-directed heart failure therapies were cautiously initiated and titrated. Following anticoagulation, she underwent successful cardioversion and subsequently demonstrated recovery of left ventricular systolic function. DISCUSSION: This case illustrates the individualized use of conventional cardiovascular therapies in a patient with MELAS and probable arrhythmia-mediated cardiomyopathy. Multidisciplinary assessment, cautious medication titration, and close monitoring allowed effective treatment while minimizing potential mitochondrial toxicity. TAKE-HOME MESSAGES: Conventional heart failure and atrial fibrillation therapies may be used in selected patients with MELAS after careful assessment of clinical benefit and potential mitochondrial risk. Multidisciplinary collaboration, cautious dose titration, and close monitoring are essential during treatment.
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Kwon et al. (2026) conducted a case report in MELAS, heart failure, and atrial fibrillation (n=1). Rate-control, guideline-directed heart failure therapies, anticoagulation, and cardioversion was evaluated on Recovery of left ventricular systolic function and successful cardioversion. Cautious initiation of rate-control and guideline-directed heart failure therapies, followed by anticoagulation and cardioversion, led to recovery of left ventricular systolic function in a patient with MELAS.
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