Impact of Atrial Fibrillation on Outcome in Takotsubo Syndrome: Data From the International Takotsubo Registry

Abstract

Background Atrial fibrillation (AF) is a major risk factor for mortality. The prevalence, clinical correlates, and prognostic impact of AF in Takotsubo syndrome (TTS) have not yet been investigated in a large patient cohort. This study aimed to investigate the prevalence, clinical correlates, and prognostic impact of AF in patients with TTS. Methods and Results Patients with TTS were enrolled from the International Takotsubo Registry, which is a multinational network with 26 participating centers in Europe and the United States. Patients were dichotomized according to the presence or absence of AF at the time of admission. Of 1584 patients with TTS, 112 (7.1%) had AF. The mean age was higher ( P <0.001), and there were fewer women ( P =0.046) in the AF than in the non‐AF group. Left ventricular ejection fraction was significantly lower ( P =0.001), and cardiogenic shock was more often observed ( P <0.001) in the AF group. Both in‐hospital ( P <0.001) and long‐term mortality ( P <0.001) were higher in the AF group. Multivariable Cox regression analysis revealed that AF was independently associated with higher long‐term mortality (hazard ratio, 2.31; 95% CI, 1.50–3.55; P <0.001). Among patients with AF on admission, 42% had no known history of AF before the acute TTS event, and such patients had comparable in‐hospital and long‐term outcomes compared with those with a history of AF. Conclusions In patients presenting with TTS, AF on admission is significantly associated with increased in‐hospital and long‐term mortality rates. Whether antiarrhythmics and/or cardioversion are beneficial in TTS with AF should thus be tested in a future trial. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01947621.

Risk Factors for Cardiac Complications in Patients With Pheochromocytoma and Paraganglioma: A Retrospective Single-Center Study

“…There were only 2 patients suffering from AF. However, previous studies ( 30 , 31 ) have shown that the in-hospital morbidity and mortality rates were significantly higher in TTC with than without AF ( 31 ). TTC and PPGL-TTC are believed to have similar physiopathology ( 5 , 6 , 32 ), and excessive CAs have also been reported to play an important role in the occurrence of adverse arrhythmias ( 33 – 36 ).Therefore, it is important to pay attention to the arrhythmias in PPGL.…”

Kidney Failure among Patients with Takotsubo Syndrome or Myocardial Infarction: A Retrospective Analysis

“…However, the pathomechanisms underlying the etiology of TTS remain multifactorial, e.g., microvascular dysfunction, vasospasm, an abnormal response to catecholamines, endothelial dysfunctions, thyroid dysfunctions, and genetic factors [ 8 , 9 , 10 , 11 , 12 ]. In TTS there is a risk of atrial and ventricular arrhythmias, cardiogenic shock, stroke, or thromboembolic events, which may explain the worsened prognosis of TTS compared to a healthy population [ 3 , 4 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ]. Furthermore, when TTS is accompanied by impaired kidney function (KF), the clinical outcomes are noted to be worse in comparison to patients with TTS alone [ 23 , 24 ].…”

Reply to “Structural And/Or Functional Underpinnings of Magnetic Resonance Imaging Bi-Atrial Strain Impairment in Patients With Takotsubo Syndrome”

“…4 Data from the international Takotsubo registry reported newly diagnosed AF in 42% of the patients at the time of TTS onset. 4 In this setting, AF might be associated with atrial inflammation. 4 Finally, as suggested by Madias, further prospective studies with a long CMR follow-up are needed to better understand the exact pathophysiology and the temporal course of the events in TTS.…”

“…4 In this setting, AF might be associated with atrial inflammation. 4 Finally, as suggested by Madias, further prospective studies with a long CMR follow-up are needed to better understand the exact pathophysiology and the temporal course of the events in TTS.…”

“…AF in TTS is related to worse in-hospital and long-term mortality rates compared with TTS patients without AF. 4 Data from the international Takotsubo registry reported newly diagnosed AF in 42% of the patients at the time of TTS onset. 4 In this setting, AF might be associated with atrial inflammation.…”