Life-Threatening Arrhythmias in Patients With Takotsubo Syndrome: Insights Into Pathophysiology and Treatment Innovations

Giulia La Vecchia; Marco Giuseppe Del Buono; Tommaso Sanna; Pier Leopoldo Capecchi; Pietro Enea Lazzerini; Michele Golino; Jordana Kron; Paula Rodriguez-Miguelez; Gemma Pelargonio; Antonio Abbate

doi:10.1016/j.jacep.2024.03.034

Life-Threatening Arrhythmias in Patients With Takotsubo Syndrome: Insights Into Pathophysiology and Treatment Innovations

JACC Clin Electrophysiol. 2024 Aug;10(8):1943-1952. doi: 10.1016/j.jacep.2024.03.034. Epub 2024 Jun 5.

Affiliations

¹ Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy; Operative Unit of Diagnostic Interventional Cardiology, Isola Tiberina-Gemelli Isola, Rome, Italy.
² Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy; Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
³ Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Division of Internal Medicine, Electroimmunology Unit, University Hospital "Le Scotte," Siena, Italy.
⁴ Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA; Robert M. Berne Cardiovascular Research Center and Division of Cardiology, University of Virginia, Charlottesville, Virginia, USA.
⁵ Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA.
⁶ Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia, USA; Division of Pulmonary and Critical Care, Virginia Commonwealth University, Richmond, Virginia, USA.
⁷ Robert M. Berne Cardiovascular Research Center and Division of Cardiology, University of Virginia, Charlottesville, Virginia, USA. Electronic address: antonio.abbate@virginia.edu.

PMID: 38842970
DOI: 10.1016/j.jacep.2024.03.034

Abstract

Takotsubo syndrome (TTS) is a reversible form of acute myocardial injury due to a neurocardiogenic mechanism associated with a relevant risk for life-threatening ventricular arrhythmias, occurring in up to 25% of all patients and including both ventricular arrhythmias (especially) in the context of QT prolongation and atrial tachy- or bradyarrhythmias. The pathogenetic mechanisms of TTS-related arrhythmic complications are not completely understood, and there are no randomized clinical trials addressing the pharmacologic and nonpharmacologic management in this specific setting. In this narrative review, the authors provide an overview of the pathogenesis and the therapeutic management of arrhythmic complications in patients with TTS, along with the future perspectives and the remaining knowledge gaps in this field.

Keywords: QT prolongation; arrhythmias; autonomic modulation; stress cardiomyopathy.

Publication types

Review

MeSH terms

Arrhythmias, Cardiac* / etiology
Arrhythmias, Cardiac* / physiopathology
Arrhythmias, Cardiac* / therapy
Electrocardiography
Humans
Takotsubo Cardiomyopathy* / complications
Takotsubo Cardiomyopathy* / physiopathology
Takotsubo Cardiomyopathy* / therapy