Stress cardiomyopathy (Tako-Tsubo) following radiofrequency ablation in the right ventricular outflow tract

Abstract

A 44-year-old female undergoing radiofrequency ablation in the right ventricular outflow tract for symptomatic, frequent premature ventricular contractions developed stress cardiomyopathy (Tako-Tsubo). Stress cardiomyopathy was probably due to hyperadrenergic state induced by the procedure itself, dobutamine infusion, sympathetic nerve stimulation at the ablation site, and parasympathetic withdrawal with atropine administration.

Mid-ventricular variant of dobutamine-induced stress cardiomyopathy

“…In a systematic review, 90% of study population had hypertension, hyperlipidemia and smoking as predisposing risk factors ( 6 ). Other comorbidities known to predispose include subarachnoid hemorrhage, following right ventricle outflow tract radiofrequency ablation and orthotopic heart transplantation ( 7 - 9 ). In our case, we believe that the following factors contributed to the development of DiSC in our patient.…”

Mid-ventricular variant of dobutamine-induced stress cardiomyopathy

“…In a systematic review, 90% of study population had hypertension, hyperlipidemia and smoking as predisposing risk factors (6). Other comorbidities known to predispose include subarachnoid hemorrhage, following right ventricle outflow tract radiofrequency ablation and orthotopic heart transplantation (7)(8)(9). In our case, we believe that the following factors contributed to the development of DiSC in our patient.…”

“…Third, centrally acting stimulants and beta-receptor agonists such as inhalers could lead to excessive sympathetic activity, thereby increasing her susceptibility to stress cardiomyopathy (11). Finally, parasympathetic withdrawal with atropine administration leads to imbalance in sympathetic-parasympathetic activity (7). Complete recovery is the rule, as seen in this case.…”

Takotsubo syndrome after concomitant surgical ablation for the treatment of atrial fibrillation in patients undergoing minimally invasive mitral valve surgery: A clinical case and review

“…The patient underwent Maze procedure surgery to treat atrial fibrillation using a monopolar probe. Some authors have suggested that the Maze procedure may contribute to TTS [ 12 ]. The mechanism in this case could be hypothesized to involve increased adrenergic tone resulting from Maze-induced damage to the X nerve [ 13 ].…”