Takotsubo Syndrome Presenting with Syncope and Third-Degree Atrioventricular Block Requiring Permanent Pacemaker Implantation

Yıl 2022, Cilt: 25 Sayı: 1, 111 - 114, 18.04.2022

Şeyhmus Külahçıoğlu Zeynep Esra Güner Barkın Kültürsay Mehmet Aytürk Ayhan Küp Abdülkadir Uslu

Öz

Takotsubo syndrome (TS) is an acute but transient heart failure syndrome and it is very uncommon for TS to present with syncope and complete atrioventricular (AV) block. In this report, we discuss a case of TS complicated by a third-degree AV block presented to the emergency department with syncope and requiring permanent pacemaker implantation. A 53-year-old female was admitted to our emergency department with complaints of syncopal episodes and chest pain. Due to ongoing chest pain, electrocardiography (ECG) findings and segmentary wall motion abnormality on the transthoracic echocardiography (TTE), she was immediately transferred to the cardiac catheterization laboratory. Coronary angiogram revealed normal coronary arteries and left ventriculography demonstrated apical ballooning and hypokinesis of the apex. Once the diagnosis of TS was established, the patient was transferred to the coronary intensive care unit (CICU). Initial ECG at CICU demonstrated complete AV block with a heart rate of 35 beats/min. On the third day of hospitalization, repeat TTE showed improved left ventricular functions with an ejection fraction of 50%. During the follow-up period in CICU, complete AV block persisted and the rhythm did not return to normal sinus rhythm after six days of monitorization. An electrophysiological study demonstrated supra-hisian atrioventricular block and atrioventricular dissociation. On the seventh day of hospitalization, TTE demonstrated recovered ventricular functions with an ejection fraction of 65%, and a dual pacemaker was then implanted. Her third-month followup was uneventful and TTE showed normal left ventricular functions but pacemaker interrogation revealed 99% of ventricular pacing. This case report demonstrated that the decision to implant a permanent pacemaker in such patients should be considered on a case-by-case basis, and an electrophysiological study could be valuable on this decision.

Anahtar Kelimeler

Cardiomyopathy, syncope, atrioventricular block, cardiac pacemaker, electrophysiology

Kaynakça

• 1. Y-Hassan S, De Palma R. Contemporary review on the pathogenesis of takotsubo syndrome: The heart shedding tears: Norepinephrine churn and foam at the cardiac sympathetic nerve terminals. Int J Cardiol 2017;228:528-36. [Crossref]
• 2. Cramer MJ, De Boeck B, Melman PG, Sieswerda GJ. The ‘broken heart’ syndrome: What can be learned from the tears and distress? Neth Heart J 2007;15:283-5. [Crossref]
• 3. Y-Hassan S. Clinical features and outcome of epinephrine-induced takotsubo syndrome: Analysis of 33 published cases. Cardiovasc Revasc Med 2016;17:450-5. [Crossref]
• 4. Brown KH, Trohman RG, Madias C. Arrhythmias in takotsubo cardiomyopathy. Card Electrophysiol Clin 2015;7:331-40. [Crossref]
• 5. Parekh A, Sengupta V, Zainea M. An unusual case report of stress-induced cardiomyopathy presenting as ventricular fibrillation cardiopulmonary arrest and third-degree atrioventricular block. Eur Heart J Case Rep 2021;5:ytab142. [Crossref]
• 6. Cativo EH, Valvani R, Mene-Afejuku TO, Cativo DP, Mushiyev S. A rare association of Takotsubo cardiomyopathy with high-degree atrioventricular block. Case Rep Cardiol 2017:6989438. [Crossref]
• 7. Nault MA, Baranchuk A, Simpson CS, Redfearn DP. Takotsubo cardiomyopathy: a novel “proarrhythmic” disease. Anadolu Kardiyol Derg 2007;7(Suppl 1):101-3.
• 8. Terui T, Iwai-Takano M, Watanabe T. Permanent pacemaker implantation in a patient with takotsubo cardiomyopathy and complete atrioventricular block. Case Rep Cardiol 2021:6637720. [Crossref]
• 9. McGee MJ, Yu W, McCarthy J, Barlow M, Hackworthy R. Complete heart block complicating takotsubo syndrome: case report and literature review. Case Rep Cardiol 2020:7614836. [Crossref]