Aims: Takotsubo cardiomyopathy (TC) or the apical ballooning syndrome is a reversible cardiomyopathy mimicking acute myocardial infarction (AMI). Although malignant arrhythmia is considered less likely to occur in TC than with AMI, sporadic reports of malignant arrhythmia with TC, however, have been reported. We reviewed the medical literature on TC and arrhythmias and describe in the summary the reported findings and discuss possible specific scenarios where arrhythmia may be more likely in patients with TC.
Methods and results: Articles were identified on PubMed using the MeSH terms 'Takotsubo Cardiomyopathy' or 'Apical Ballooning Syndrome'. Seventy-four unique case series with five or more TC patients were identified, with a cumulative total of 1876 cases. Twelve series (242 cases) were excluded because Mayo criteria were not met. Twenty-five series (816 cases, 43.5%) reported on arrhythmia and were included in the analysis.
Conclusion: Areas for further prospective study include the duration and mechanism of residual risk and optimal risk stratification and modification. The current state of evidence would support beta-blockers in the acute setting to control tachyarrhythmia, although there is little evidence to support their use beyond convalescence when used for this indication alone. Those in heart failure and cardiogenic shock should be managed with established evidence-based therapies for these conditions. The use of internal defibrillators in TC requires consideration only on a case-by-case basis.