Jesel L, et al. - Researchers evaluated the incidence and outcome of life-threatening arrhythmia (LTA) in Takotsubo cardiomyopathy (TTC), and its predictive factors and clinical implications. They noted that in patients presenting with TTC, LTA occurs early and is associated with significantly worse short- and long-term prognosis. Independent predictors of LTA are left ventricular impairment and QRS duration>105 ms. Hospital survivors experienced ventricular arrhythmias in the acute phase without further recurrence, however, a persistence of severe conduction disorders was noted during long-term follow-up. Findings seem to have implications on the choice of device therapy on this specific patient subgroup.

Methods

• Two hundred and fourteen consecutive cases of TTC were studied over 8 years.
• The study corhort was split into two groups – those with and without LTA (LTA-group/non-LTA-group).
• Researchers defined LTA as ventricular tachycardia (VT), ventricular fibrillation (VF) or cardiac arrest.

Results

• In 10.7% of patients, LTA occurred, mainly in the first 24-hours of hospitalization: VT (n=2), VF (n=11), cardiac arrest (n=10: 5 asystole, 3 complete heart block, 2 sinoatrial block).
• Lower LVEF and a high rate of conduction disturbances were linked to LTA.
• The LTA-group showed significantly increased in-hospital (39.1% vs 8.9%, p<0.001) and one-year mortality (47.8% vs 14.1%, p<0.001). LVEF and QRS duration>105 ms independently predicted LTA.
• Conduction disturbances persisted after the index event in cases where a device was implanted despite complete recovery of LVEF.
• No ventricular arrhythmia recurrence was seen during follow-up.