Management of arrhythmias in patients with Takotsubo cardiomyopathy: Is the implantation of permanent devices necessary?

Heart Rhythm. 2016 Oct;13(10):1979-86. doi: 10.1016/j.hrthm.2016.06.013. Epub 2016 Jun 11.


Background: Arrhythmias are frequent in Takotsubo cardiomyopathy (TTC) and a major determinant of outcome.

Objective: The purpose of this study was to provide a rationale for management strategies, particularly for permanent device implantation given the reversible nature of TTC.

Methods: Treatment strategies of arrhythmias including ventricular fibrillation (VF), ventricular tachycardia (VT), asystole, pulseless electrical activity, and complete atrioventricular (AV) or sinoatrial block were assessed in a bicentric cohort of consecutive patients with TTC (n = 286) with a mean follow-up period of 3.3 ± 2.4 years.

Results: The prevalence of arrhythmias during the acute phase of TTC was 12.2% (n = 35), consisting predominantly of VT (n = 16 [5.6%]), VF (n = 7 [2.4%]), and complete AV block (n = 8 [2.8%]). Seven patients received a permanent pacemaker because of complete AV (n = 6) or sinoatrial (n = 1) block. Regular device checkups were available in 2 patients and demonstrated ongoing high-degree AV block despite recovery of left ventricular function. Three patients with transient bradyarrhythmias who did not receive devices died shortly after hospital discharge from unknown causes. One patient received an implantable cardioverter-defibrillator after resuscitation for VF and did not require device interventions during 2-year follow-up. Patients with polymorphic VT (n = 7), monomorphic VT (n = 6), or VF (n = 2) who were discharged from hospital survived or died of noncardiac reasons, with the cause of death remaining unclear in 1 patient with monomorphic sustained VT.

Conclusion: Our data suggest that bradyarrhythmias in the acute setting of TTC may require permanent pacemaker implantation. In contrast, polymorphic ventricular arrhythmias might be managed with a temporary approach (eg, wearable cardioverter-defibrillators) until recovery of repolarization time and left ventricular function.

Keywords: Apical ballooning syndrome; Arrhythmia; Implantable cardioverter-defibrillator; Permanent pacemaker; Stress cardiomyopathy; Takotsubo.

MeSH terms

  • Aged
  • Arrhythmias, Cardiac* / etiology
  • Arrhythmias, Cardiac* / mortality
  • Arrhythmias, Cardiac* / physiopathology
  • Arrhythmias, Cardiac* / therapy
  • Bradycardia / etiology
  • Bradycardia / physiopathology
  • Bradycardia / therapy*
  • Death, Sudden, Cardiac / etiology
  • Death, Sudden, Cardiac / prevention & control*
  • Defibrillators, Implantable* / classification
  • Defibrillators, Implantable* / statistics & numerical data
  • Electrocardiography / methods
  • Female
  • Finland / epidemiology
  • Heart Conduction System / physiopathology
  • Humans
  • Male
  • Middle Aged
  • Pacemaker, Artificial / statistics & numerical data*
  • Survival Analysis
  • Takotsubo Cardiomyopathy* / complications
  • Takotsubo Cardiomyopathy* / epidemiology
  • Takotsubo Cardiomyopathy* / physiopathology