Takotsubo cardiomyopathy following pacemaker insertion complicated with polymorphic ventricular tachycardia: a case report.
Pacemaker induced
Polymorphic ventricular tachycardia
Takotsubo cardiomyopathy
Journal
Journal of medical case reports
ISSN: 1752-1947
Titre abrégé: J Med Case Rep
Pays: England
ID NLM: 101293382
Informations de publication
Date de publication:
06 May 2024
06 May 2024
Historique:
received:
22
02
2023
accepted:
14
04
2024
medline:
6
5
2024
pubmed:
6
5
2024
entrez:
5
5
2024
Statut:
epublish
Résumé
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. 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. 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.
Sections du résumé
BACKGROUND
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
METHODS
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
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.
Identifiants
pubmed: 38705996
doi: 10.1186/s13256-024-04565-5
pii: 10.1186/s13256-024-04565-5
doi:
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
238Informations de copyright
© 2024. Crown.
Références
Akashi YJ, Goldstein DS, Barbaro G, Ueyama T. Takotsubo cardiomyopathy: a new form of acute, reversible heart failure. Circulation. 2008;118(25):2754–62.
doi: 10.1161/CIRCULATIONAHA.108.767012
pubmed: 19106400
pmcid: 4893309
Agarwal S, Sanghvi C, Odo N, Castresana MR. Perioperative takotsubo cardiomyopathy: implications for anesthesiologist. Ann Card Anaesth. 2019;22(3):309–15.
doi: 10.4103/aca.ACA_71_18
pubmed: 31274495
pmcid: 6639891
Kapoor S. Rare etiological causes of Takotsubo cardiomyopathy regarding “Takotsubo cardiomyopathy after treatment of pulmonary arterial hypertension.” Pulm Circ. 2013;3(1):122–3.
doi: 10.4103/2045-8932.109930
pubmed: 23662186
pmcid: 3641717
Kotsakou M, Kioumis I, Lazaridis G, Pitsiou G, Lampaki S, Papaiwannou A, et al. Pacemaker insertion. Ann Transl Med. 2015;3(3):42.
pubmed: 25815303
pmcid: 4356861
Postema PG, Wiersma JJ, van der Bilt IA, Dekkers P, van Bergen PF. Takotsubo cardiomyopathy shortly following pacemaker implantation-case report and review of the literature. Netherlands Heart J. 2014;22(10):456–9.
doi: 10.1007/s12471-012-0320-8
Wei ZH, Dai Q, Wu H, Song J, Wang L, Xu B. Takotsubo cardiomyopathy after pacemaker implantation. J Geriatr Cardiol JGC. 2018;15(3):246–8.
pubmed: 29721007
Kohnen RF, Baur LH. A Dutch case of a takotsubo cardiomyopathy after pacemaker implantation. Netherlands Heart J. 2009;17(12):487–90.
doi: 10.1007/BF03086309
Pelliccia F, Kaski JC, Crea F, Camici PG. Pathophysiology of Takotsubo Syndrome. Circulation. 2017;135(24):2426–41.
doi: 10.1161/CIRCULATIONAHA.116.027121
pubmed: 28606950
Dashwood A, Rahman A, Marashi HA, Jennings C, Raniga M, Dhillon P. Pacemaker-induced takotsubo cardiomyopathy. HeartRhythm Case Rep. 2016;2(3):272–6.
doi: 10.1016/j.hrcr.2016.02.005
pubmed: 28491688
pmcid: 5419770
Gardini A, Fracassi F, Boldi E, Albiero R. Apical Ballooning syndrome (Takotsubo Cardiomyopathy) after permanent dual-chamber pacemaker implantation. Case Rep Cardiol. 2012;2012: 308580.
pubmed: 24826241
pmcid: 4008404
Machuki JO, Zhang HY, Harding SE, Sun H. Molecular pathways of oestrogen receptors and β-adrenergic receptors in cardiac cells: Recognition of their similarities, interactions and therapeutic value. Acta Physiol. 2018;222(2): e12978.
doi: 10.1111/apha.12978
Potu KC, Raizada A, Gedela M, Stys A. Takotsubo Cardiomyopathy (Broken-Heart Syndrome): A Short Review. South Dakota Med. 2016;69(4):169–71.
Möller C, Eitel C, Thiele H, Eitel I, Stiermaier T. Ventricular arrhythmias in patients with Takotsubo syndrome. J Arrhythm. 2018;34(4):369–75.
doi: 10.1002/joa3.12029
pubmed: 30167007
pmcid: 6111471
Elsokkari I, Abdelwahab A, Parkash R. Polymorphic ventricular tachycardia due to change in pacemaker programming. HeartRhythm Case Rep. 2017;3(5):243–7.
doi: 10.1016/j.hrcr.2017.02.003
pubmed: 28736705
pmcid: 5509919