Takotsubo cardiomyopathy after left bundle branch pacing: A case report

Takotsubo Syndrome After Pacemaker Implantation: A Case Report and Literature Review

“…These reports described 13 patients with TTS following pacemaker implantation for AV block (38% men); the correlation between implantation and TTS was less clear because there were other confounding factors, such as the use of isoproterenol before the procedure, concomitant lead extraction, and complications occurring during or shortly after the procedure (ie, pneumothorax, lead dislodgment). Interestingly, in one of these case reports, Scuotto et al 8 described a case of TTS occurring after LBB pacing, which is a much more physiological pacing modality compared to RV apical/septal pacing; the patient was a 93-year-old man who developed TTS and cardiogenic shock immediately after an uncomplicated procedure of extraction of an old malfunctioning RV apical lead and concomitant reimplantation of a new lead in the LBB.…”

“…Many questions regarding TTS after pacemaker implantation still remain open, including whether there are predicting factors to risk-stratify patients, but only a multicenter prospective study could provide answers to this and other issues. 2 , 7 , 8 Based on currently available knowledge, despite a benign clinical course in most cases, efforts should be focused on an early diagnosis, also considering a significant percentage of initially asymptomatic cases. An ECG combined with a simple fast echocardiogram before discharge could identify TTS signs, especially in patients deemed at a higher risk of this rare but fearsome complication.…”

To the Editor—Left bundle branch pacing as cause for takotsubo cardiomyopathy?

“…Scuotto and colleagues 1 recently published a case report on takotsubo cardiomyopathy (TCM) after left bundle branch pacing in a 93-year-old man. The insertion of a left bundle branch pacing lead took place after extraction of a failing pacing lead implanted 14 years prior.…”