Takotsubo cardiomyopathy related complete heart block: a nationwide cohort analysis

Abstract

Abstract Background Complete heart block (CHB) is considered to be a relatively rare complication of Takotsubo cardiomyopathy (TC), a condition characterized by transient left ventricular systolic dysfunction. Purpose We aim to investigate the incidence, in-hospital mortality and trends of permanent pacemaker (PPM) placement in patients with TC-related CHB. Methods We utilized the United States National Inpatient Sample (NIS) data from 2010–2014 to identify adult patients (≥18 years) with TC (ICD 9 code: 429.83). CHB cases were identified using ICD-9 code 426.0. Annual incidence of CHB, in-hospital mortality and trends of PPM placement were analyzed. Cochran-Armitage test was employed and p values were calculated for trend. Results A total of 56,431 patients with TC were identified, of which 495 (0.7%) had CHB (median age 71 years, 85% women). Incidence of TC-related CHB was 0.5% in 2010 and 0.8% in 2014. However, trend analysis did not show an increase in the incidence (ptrend=0.12). In-hospital mortality was higher in patients with CHB (7.5% vs. 2.9%, aOR = 1.9, 95% CI= 1.29–2.8, p=0.001). Temporary transvenous pacemaker (TTVP) was used in 158 (40.1%) and PPM in 217 (54.9%) patients. Trend analysis showed a significant increase in the PPM placement from 41.9% in 2010 to 76.2% in 2014 and a simultaneous decrease in use of TTVP (ptrend<0.001). Median length of stay (4 vs. 3 days, p<0.001) was prolonged and hospitalization cost ($92,731 vs. $35,905, p<0.001) was higher in TC patients with CHB. Conclusion TC-related CHB is uncommon, but independently associated with increased in-hospital mortality. The majority of these patients required PPM, implicating a non-reversible feature of the conduction system abnormality. Funding Acknowledgement Type of funding source: None