Abstract
BackgroundDirect current cardioversion is a well-established and safe procedure to restore normal sinus rhythm for atrial and ventricular arrhythmias. Takotsubo syndrome has been rarely described with cardioversion. We reviewed the literature for descriptions of Takotsubo syndrome associated with the stress of cardioversion, to better understand its risks.MethodsWe queried MEDLINE, EMBASE, Google Scholar and Cochrane for cases of Takotsubo syndrome secondary to synchronized cardioversion as defined by Mayo Clinic Diagnostic Criteria.ResultsWe identified 11 cases of cardioversion-associated Takotsubo syndrome. Average age was 76 years (range: 61–87 years) and most (10 out of 11, 91%) were female. Diagnosis was made soon after cardioversion (median: 10 h, range: 0–48 h). Only 2 of 11 had ST elevations noted, while apical ballooning was noted in all cases. Pulmonary edema developed in 6 and cardiogenic shock developed in 5 patients. The median recovery time was 7 days (range: 3–11).ConclusionsCardioversion-associated TS has an overall favorable outcome with complete recovery in most cases. A higher risk of this complication may exist for elderly females undergoing synchronized cardioversion.
Highlights
Direct current cardioversion is a well-established, safe, and effective procedure to restore normal sinus rhythm for both atrial and ventricular arrhythmias [1]
To better understand the association between direct current cardioversion and Takotsubo syndrome (TS), we performed a systematic review of the literature for cases describing patients with TS following Direct current (DC) cardioversion and studied the patient demographics, procedural characteristics, and disease outcomes
Search strategy We performed a comprehensive database search on MEDLINE, EMBASE, Google Scholar and Cochrane database of systematic reviews for case reports, case series and observational studies describing cases of Takotsubo cardiomyopathy or syndrome associated with synchronized direct current cardioversion from inception until January 1, 2020
Summary
Direct current cardioversion is a well-established, safe, and effective procedure to restore normal sinus rhythm for both atrial and ventricular arrhythmias [1]. TS is a severe transient left ventricular dysfunction with regional wall motion abnormalities that may present with electrocardiogram (ECG) changes and/or elevated biomarkers in the absence of significant obstructive coronary artery disease [2,3,4,5,6]. This complex disease has a predilection to occur in females who are postmenopausal with a mean age of 67 years [3]. Direct current cardioversion is a well-established and safe procedure to restore normal sinus rhythm for atrial and ventricular arrhythmias. We reviewed the literature for descriptions of Takotsubo syndrome associated with the stress of cardioversion, to better understand its risks
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