Low-Amplitude Electrocardiogram in a Patient with Atrial Fibrillation, Direct-Current Electrical Cardioversion, and Takotsubo Cardiomyopathy

Abstract

To the Editor:I read with pleasure the report by Siegfried and colleagues1 about a woman with atrial fibrillation who had an episode of takotsubo cardiomyopathy (TC) immediately after undergoing direct-current electrical cardioversion of her atrial fibrillation. In their discussion, the authors provide a convincing and comprehensive analysis of the incident.I was impressed with the low voltage in the admission electrocardiogram (ECG) and in the one after cardioversion. Transient low-voltage ECG has been described recently in association with TC2; accordingly, I would greatly appreciate information on the patient's ECGs before hospital admission and at follow-up. If these ECGs did not reveal low voltage, then TC was present before the hospital admission as a result of atrial fibrillation, even though the authors did not observe the consequences of TC in the echocardiogram and the release of cardiac troponin I before cardioversion.doi: http://dx.doi.org/10.14503/THIJ-14-4486I thank Dr. Madias for his insightful response to our report.1 In regard to the patient's electrocardiographic (ECG) voltage, review of the available data reveals low voltage in the limb and precordial leads 2 years before her presentation (Fig. 1), which was the most recent prior ECG. An ECG obtained at the time of follow-up, 2 weeks after the patient's discharge from the hospital, showed similar findings (Fig. 2). Although there appears to be a general association between low voltage and takotsubo cardiomyopathy,2 in this case the low voltage appears to have been the patient's baseline status, most likely due to body habitus.