Incidence, characteristics, risk factors and outcomes of supraventricular arrhythmias in Takotsubo cardiomyopathy

Abstract

Takotsubo cardiomyopathy (TTC) is a medical entity mimicking an acute coronary syndrome (ACS). During the acute phase, several complications may occur, even if the prognosis is generally favorable. Only small studies reported a description of supraventricular arrhythmia (SA) in TTC and little is known about related incidence. We sought to describe the characteristics, incidence, predictive factors and outcomes of SA inpatients presenting with TTC. Over a twelve-year period, we reviewed all patients ( n = 5484) referred to our coronary care unit (CCU) for a suspicion of ACS. All patients presented with a confirmed diagnosis of TTC and a normalization of left ventricular ejection fraction (LEVF) during follow-up. In CCU, all patients were continually monitored by 12-lead ECG to detect the occurrence of SA. TTC was diagnosed in 88 patients according to the Mayo Clinic criteria, in sinus rhythm at the time of diagnosis. Incidence of SA among TTC was 14%. A difference was observed between patients with or without SA occurrence: age, hypertension, systolic pulmonary artery pressure and duration of hospitalization. Of note, patient with SA had significantly more depressed left ventricular ejection fraction at admission ( P = 0.006). A large part of patient presenting SA required the use of diuretic for heart failure during hospitalization ( P = 0.026). In multivariate analysis, the factors significantly associated with an increased risk of VA were: age ( aOR = 1.19, 95% CI: 1.01–1.39, P = 0.029) and LEVF ( aOR = 0.89, 95% CI: 0.8–0.97; P = 0.037). There was no significant difference in mortality rate between patients with or without SA during follow-up. SA occurred in 14% of patients at the acute phase of TTC and independent predictive factors of SA were age and LEVF. During the acute phase, identification of high-risk SA patients allows better management, with ECG monitoring and therapeutic intervention in the CCU.