Abstract
This case report presents a patient with Takotsubo cardiomyopathy (TCM) and complete atrioventricular (AV) block who was treated with permanent pacemaker implantation. A 78-year-old woman with a history of hypertension presented with a 6-month history of palpitations. On initial evaluation, her heart rate was 40 beats/minute. Electrocardiography revealed a complete AV block and T-wave inversion in these leads: I, II, aVL, aVF, and V3–6. Echocardiography showed akinesis from the midventricle to the apex and hyperkinesis on the basal segments. The patient was diagnosed with TCM and complete AV block. Because improvement of TCM may subsequently improve the AV node dysfunction associated with TCM, the patient was admitted for treatment of heart failure without pacemaker implantation. The left ventricular (LV) abnormal wall motion improved gradually; however, the AV block persisted intermittently. On hospital day 14, a pause of 5–6 seconds without LV contraction was observed, and permanent pacemaker implantation was performed. On day 92, echocardiography revealed normal LV wall motion. However, electrocardiography revealed that the pacemaker rhythm with atrial sensing and ventricular pacing remained. Although specific degree of damage that may result from AV block associated with TCM is unknown, some of these patients require pacemaker implantation, despite improvement of abnormality in LV wall motion.
Highlights
Takotsubo cardiomyopathy (TCM) is known as stressinduced heart disease that occurs with transient acute left ventricle (LV) apical ballooning without coronary artery stenosis
Because the specific degree of damage that occurs in AV conduction in the setting of TCM is unknown, the best method for the management of advanced AV block associated with TCM remains unclear [8]
This case report presents a patient with persistent AV block-complicated TCM, the treatment of which was permanent pacemaker implantation in the process of improving LV dysfunction
Summary
Takotsubo cardiomyopathy (TCM) is known as stressinduced heart disease that occurs with transient acute left ventricle (LV) apical ballooning without coronary artery stenosis. Only a few reports have described TCM patients with AV block who underwent pacemaker implantation Among those reports, AV node dysfunction remained even after LV contraction was improved [4,5,6]. Because the specific degree of damage that occurs in AV conduction in the setting of TCM is unknown, the best method for the management of advanced AV block associated with TCM remains unclear [8]. This case report presents a patient with persistent AV block-complicated TCM, the treatment of which was permanent pacemaker implantation in the process of improving LV dysfunction
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