Ventricular arrhythmias and sudden cardiac arrest in Takotsubo cardiomyopathy: Incidence, predictive factors and clinical implications.

Abstract

Takotsubo cardiomyopathy (TTC) is a stress-related transient cardiomyopathy. Life threatening arrhythmias (LTA) can occur and worsen prognosis. The purpose of this study was to assess the incidence and outcome of LTA in TTC, its predictive factors and clinical implications. We studied 214 consecutive cases of TTC over 8 years. The study cohort was divided into two groups - those with LTA (LTA-group) and those without (non-LTA-group). LTA was defined as ventricular tachycardia (VT), ventricular fibrillation (VF) or cardiac arrest. LTA occurred in 10.7% of patients 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). LTA were associated with lower LVEF and high rate of conduction disturbances. In-hospital (39.1% vs 8.9%, p<0.001) and one-year mortality (47.8% vs 14.1%, p<0.001) were significantly increased in the LTA-group. LVEF and QRS duration>105 ms were independent predictors of LTA. In cases where a device was implanted, conduction disturbances persisted after the index event despite complete recovery of LVEF. There was no ventricular arrhythmia recurrence during follow-up. LTA occur early in patients presenting with TTC and is associated with significantly worse short and long-term prognosis. Left ventricular impairment and QRS duration>105 ms are independent predictors of LTA. Ventricular arrhythmias occurred in the acute phase without further recurrence recorded among hospital survivors whereas severe conduction disorders persisted during long-term follow-up. These findings may have implications on the choice of device therapy on this specific patient subgroup.