Ventricular Arrhythmic Complications in Apical Ballooning Takotsubo Syndrome

Dec 19, 2022
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Authors:
Del Buono MG, Damonte JI, Moroni F, et al.
Citation:
QT Prolongation and In-Hospital Ventricular Arrhythmic Complications in Patients With Apical Ballooning Takotsubo Syndrome. JACC Clin Electrophysiol 2022;8:1500-1510.
Summary By:
Thomas C. Crawford, MD, FACC

Quick Takes

  • In a study of a diverse group of patients with Takotsubo cardiomyopathy, 11% of patients experienced a ventricular arrhythmic complication and had significantly longer QTC.
  • QTC was an independent predictor of ventricular arrhythmias with an odds ratio of 1.09 for each 10-millisecond increase in QTC.

Study Questions:

What is the association of QT interval on electrocardiogram with ventricular arrhythmic complications in patients hospitalized with apical ballooning Takotsubo syndrome?

Methods:

Inpatient charts of patients with apical ballooning Takotsubo syndrome admitted from 2011 to 2017 were reviewed. QT interval was adjusted for rate using the Fridericia formula (QTCF). Chart review identified arrhythmic complications during the hospitalization.

Results:

There was a total of 105 patients: 82% were female and 32% were Black/African American. The mean age was 65 years. Mean left ventricular ejection fraction was 25%. Ten (11%) patients experienced a ventricular arrhythmic complication and had significantly longer QTCF (470 [range, 422-543] milliseconds) than did those without complications (417 [range, 383-456] milliseconds, p = 0.031). The area under the curve for QTCF was 0.708 (p = 0.031). Twenty-eight (27%) patients had a QTCF ≥460 milliseconds and significantly more arrhythmic complications (21% vs. 5%, odds ratio, 5.0; p = 0.021). QTCF was an independent predictor of ventricular arrhythmias.

Conclusions:

The authors concluded that in patients with apical ballooning Takotsubo syndrome admitted to a large urban hospital in the United States, QTCF at admission ≥460 milliseconds identifies patients at high risk for in-hospital arrhythmic complications.

Perspective:

Much of the literature on Takotsubo comes from European and Asian registries or case series. The current paper builds on and extends those findings to include the US population with one-third being Black/African American. The authors demonstrate increasing risk of ventricular arrhythmia in patients with increasing QT intervals. Interestingly, patients with prior cerebrovascular accidents were also more likely to have prolonged QTC and have a high incidence of in-hospital arrhythmic events. Further studies will be needed to ascertain whether strategies aimed at shortening QT interval through neural modulation could potentially prevent life-threatening arrhythmic events.

Clinical Topics: Acute Coronary Syndromes, Arrhythmias and Clinical EP, Congenital Heart Disease and Pediatric Cardiology, Heart Failure and Cardiomyopathies, Implantable Devices, Genetic Arrhythmic Conditions, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Congenital Heart Disease, CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Quality Improvement, Acute Heart Failure

Keywords: Acute Coronary Syndrome, Arrhythmias, Cardiac, Cardiomyopathies, Electrocardiography, Heart Failure, Inpatients, Long QT Syndrome, Risk, Stroke, Stroke Volume, Takotsubo Cardiomyopathy, Vascular Diseases, Ventricular Function, Left


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