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Takotsubo cardiomyopathy following pacemaker insertion complicated with polymorphic ventricular tachycardia: a case report.
Dev, Damanpreet; El-Din, Mohammed; Vijayakumar, Siddharth; Mitrakrishnan, Rayno Navinan.
Affiliation
  • Dev D; Department of Cardiology, Kettering General Hospital, NHS, Kettering, UK. damanpreet.dev@nhs.net.
  • El-Din M; Department of Cardiology, Kettering General Hospital, NHS, Kettering, UK.
  • Vijayakumar S; Department of Cardiology, Kettering General Hospital, NHS, Kettering, UK.
  • Mitrakrishnan RN; University Hospital-Kotelawala Defence University, Colombo, Sri Lanka.
J Med Case Rep ; 18(1): 238, 2024 May 06.
Article in En | MEDLINE | ID: mdl-38705996
ABSTRACT

BACKGROUND:

Takotsubo cardiomyopathy is a novel form of rapidly reversible heart failure occurring secondary to a stressor that mimics an acute coronary event. The underlying etiology of the stressor is highly variable and can include medical procedures. Pacemaker insertion is an infrequent cause of Takotsubo cardiomyopathy. CASE PRESENTATION An 86-year-old Caucasian woman underwent an uncomplicated pacemaker insertion for symptomatic complete heart block in the background of slow atrial fibrillation. A transient episode of polymorphic ventricular tachycardia was noted on day 1 following the procedure; however, her pacemaker was checked and, as she remained stable, she was discharged home. She presented again 5 days later with symptomatic heart failure. Chest X-ray confirmed pulmonary edema. Echocardiography confirmed new onset severe left ventricle dysfunction. Pacemaker checks were normal and lead placement was confirmed. Though her troponin I was elevated, her coronary angiogram was normal. Contrast enhanced echocardiography suggested apical ballooning favoring Takotsubo cardiomyopathy. She was treated for heart failure and made a good recovery. Her follow-up echocardiography a month later showed significant improvement in left ventricle function.

CONCLUSIONS:

Takotsubo cardiomyopathy is mediated by a neuro-cardiogenic mechanism due to hypothalamic-pituitary-adrenal axis activation. It generally has a good prognosis. Complications though uncommon, can occur and include arrhythmias. Pacemaker insertion as a precipitant stressor is an infrequent cause of Takotsubo cardiomyopathy. As pacemaker insertions are more frequent in the elderly age group, this phenomenon should be recognized as a potential complication.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Pacemaker, Artificial / Tachycardia, Ventricular / Takotsubo Cardiomyopathy Limits: Aged80 / Female / Humans Language: En Journal: J Med Case Rep Year: 2024 Type: Article Affiliation country: United kingdom

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Pacemaker, Artificial / Tachycardia, Ventricular / Takotsubo Cardiomyopathy Limits: Aged80 / Female / Humans Language: En Journal: J Med Case Rep Year: 2024 Type: Article Affiliation country: United kingdom