Abstract 21032: Ventricular Tachycardia and Atrial Fibrillation Complicating the Clinical Course of Tako-tsubo Cardiomyopathy: Results of the German Tako-tsubo Registry
Background: Arrhythmias may complicate the clinical course of tako-tsubo cardiomyopathy (TTC). This study evaluated the incidence and clinical relevance of ventricular arrhythmias and atrial fibrillation (AF) in pts of the German TTC registry.
Methods: From 37 hospitals, 324 pts (296 f, 28 m, age 68±12) were included in the registry. Seven pts (2.2%) died (cardiogenic shock n=4; myocardial rupture, stroke and asystole n=1 each); 209 pts were continuously monitored and had daily ECG recordings for evaluation of arrhythmias.
Results: Ventricular tachycardia (VT) was documented in 17 pts (8%) and newly diagnosed AF in 32 pts (15%). TTC pts with and without arrhythmias were compared. In pts with VT, time from symptom onset to hospital admission was shorter (3.8±3.2 vs 8.7±7.3 hours, p<0.001). Pulmonary edema (29% vs 12%, p<0.05), need for intraaortic balloon pumping (6% vs 0.5%, p<0.05), resuscitation (18% vs 3%, p<0.002) and left ventricular thrombi (12% vs 3%, p=0.05) were seen more frequently. The QTc interval was slightly more prolonged (476±45 vs 470±55 ms day 1, 521±80 vs 510±57 ms day 2, 533±93 vs 508±60 ms day 3, all p=ns). Heart rate and other ECG changes were similar. Regarding age, sex, symptoms, trigger events, cardiac markers, ejection fraction, ballooning pattern, medication and mortality there was no significant difference among pts with and without VT. Pts with AF frequently were on a pre-medication with diuretics (50% vs 12%, p<0.005), had a lower ejection fraction (45±14% vs 52±15%, p<0.02) and presented more frequently with pulmonary edema (25% vs 11%, p<0.05) or cardiogenic shock (16% vs 5%, p<0.05). Age, sex, symptoms, trigger events, cardiac markers, ECG changes, ballooning pattern, medication other than diuretics, and mortality were not significantly different among pts with and without newly diagnosed AF. Resuscitation was performed in 8/209 pts (4%); 2 pts died. Of the remaining 6 pts, 3 on beta-blocker treatment and 1 pt with ICD implantation were free of arrhythmias over a follow-up period of 20–41 months.
Conclusions: During the acute phase of TTC, ventricular arrhythmias occurred in 8% and atrial fibrillation in 15% of pts with a more complicated clinical course. After resuscitation, no VT or sudden cardiac death was observed during follow-up.
- © 2010 by American Heart Association, Inc.