Sudden cardiac death: An increasingly recognized presentation of apical ballooning syndrome (Takotsubo cardiomyopathy)

Myocardial edema as a substrate of electrocardiographic abnormalities and life-threatening arrhythmias in reversible ventricular dysfunction of takotsubo cardiomyopathy: Imaging evidence, presumed mechanisms, and implications for therapy

“…[15][16][17][18][19][20][21] Long-short sequences preceding torsades de pointes/VF have also been reported, which were similar to those traditionally recognized as arrhythmia triggers in acquired long QT syndrome ( F6 Figure 6). Accordingly, TTC should be regarded as a new variant of acquired long QT syndrome at risk of malignant arrhythmic events.…”

“…Sudden cardiac arrest has been found to occur more often in men than in women. [15][16][17][18][19][20][21] Life-threatening ventricular arrhythmias and cardiac arrest maybe the modality of presentation of TTC. 47 The mechanism of these arrhythmias in the acute phase of TTC is most likely distinct from that of the subacute phase (ie, unrelated to QT interval prolongation), with acute catecholamines toxicity and/or myocardial ischemia playing a significant role.…”

“…47,48 Life-threatening ventricular arrhythmias most often occur in the subacute phase (on the second and third hospital days) at the same time of ECG changes in anterolateral T-wave inversion and QT interval prolongation. [15][16][17][18][19][20][21] Clinical studies specifically addressing the incidence and outcome of ventricular arrhythmias in patients with TTC consistently showed that the majority of malignant arrhythmic episodes were related to QT interval prolongation 451 452 453 454 455 456 457 458 459 ...…”

“…[10][11][12] TTC is usually characterized by prominent ECG changes consisting of mild ST-segment changes, followed by T-wave inversion and QT interval prolongation 13,14 ; life-threatening ventricular arrhythmias and sudden arrhythmic death may also occur at presentation or in the subacute stage of the disease course. [15][16][17][18][19][20][21] Contrast-enhanced cardiac magnetic resonance (CE-CMR Q5 ) has become the criterion standard imaging technique for tissue characterization and identification of myocardial lesions such as edema and fibrosis, which may represent the substrate for ventricular electrical disturbances in TTC. [22][23][24] The present study addresses the evolving concepts in the pathogenesis of ECG changes and rhythm/conduction abnormalities in TTC.…”

Epidemiology and Clinical Profile of Takotsubo Cardiomyopathy

“…47, 66 In patients experiencing cardiac arrest, it may be uncertain whether TTC should be incriminated as the cause or alternatively the consequence of the arrhythmia. The profound stress of cardiac arrest and subsequent resuscitation (sometimes with administration of epinephrine) can itself trigger a TTC event.…”