Log in to MyACC
Cardiac Arrest in Takotsubo Syndrome
Study Questions:
What is the frequency and what are the clinical features and prognostic implications of cardiac arrest (CA) in takotsubo syndrome (TTS)?
Methods:
Records of patients with CA and known heart rhythm from the International Takotsubo Registry were analyzed. The main outcomes were 60-day and 5-year mortality. In addition, predictors of mortality and predictors of CA during the acute TTS phase were assessed.
Results:
From a total of 2,098 patients in the registry, 103 patients with CA and known heart rhythm during CA were included. Compared with patients without CA, CA patients were more likely to be younger and male, and to have apical TTS, atrial fibrillation (AF), neurologic comorbidities, physical triggers, longer corrected QT interval, and lower left ventricular ejection fraction on admission. In all, 57.1% of patients with CA at admission had ventricular fibrillation/tachycardia, while 73.7% of patients with CA in the acute phase had asystole/pulseless electrical activity (PEA). Patients with CA showed higher 60-day (40.3% vs. 4.0%, p < 0.001) and 5-year mortality (68.9% vs. 16.7%, p < 0.001) than patients without CA. T-wave inversion and intracranial hemorrhage were independently associated with higher 60-day mortality after CA, whereas female gender was associated with lower 60-day mortality. In the acute phase, CA occurred less frequently in females and more frequently in patients with AF, ST-segment elevation, and higher C-reactive protein on admission.
Conclusions:
The authors concluded that CA is relatively frequent in TTS and is associated with higher short- and long-term mortality.
Perspective:
This report suggests that CA is relatively frequent in TTS. It is not possible to be sure whether TTS is the cause or the consequence of CA, although the former explanation seems more likely. Most of the arrests occurred at presentation, rather in the acute phase of the disease, so the adverse outcomes and mortality are very high. In this mostly female disease, males fared poorly. T-wave inversions and intracranial hemorrhage emerged as predictors of mortality at 60 days. The rate of PEA was quite high in comparison to ventricular tachycardia and ventricular fibrillation, especially during the acute phase. The vast majority of discharged patients were not offered an implantable cardioverter-defibrillator, and the authors report no correlation between device implantation and 5-year mortality. For unclear reasons, out-of-hospital CA was not associated with higher mortality than in-hospital CA, and patients with CA during the acute phase had a trend towards higher mortality compared with patients with CA at initial presentation.
Clinical Topics: Acute Coronary Syndromes, Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, ACS and Cardiac Biomarkers, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure, Heart Failure and Cardiac Biomarkers
Keywords: Acute Coronary Syndrome, Arrhythmias, Cardiac, Atrial Fibrillation, C-Reactive Protein, Defibrillators, Implantable, Heart Arrest, Heart Failure, Intracranial Hemorrhages, Tachycardia, Ventricular, Takotsubo Cardiomyopathy, Ventricular Fibrillation
< Back to Listings
