Takotsubo Cardiomyopathy after Permanent Pacemaker Implantation: Insights from a Rare Clinical Case

From Top Italian Scientists Journal
Published
March 5, 2025
Title
Takotsubo Cardiomyopathy after Permanent Pacemaker Implantation: Insights from a Rare Clinical Case
Authors
Anna Sirignano, Rita Di Rosa, Marco Petrassi, Massimo Mastroluca, Giuseppe Biondi-Zoccai, Francesco Versaci
DOI
10.62684/VHWI2096
Keywords
Apical ballooning syndrome; Pacemaker implantation; Takotsubo cardiomyopathy.
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Anna Sirignano(a), Rita Di Rosa(b), Marco Petrassi(c), Massimo Mastroluca(d), Giuseppe Biondi-Zoccai(e,f), Francesco Versaci(g)

(a) Division of Cardiology, Santa Maria Goretti Hospital, Latina, Italy. an.sirignano@gmail.com

(b) Division of Cardiology, Santa Maria Goretti Hospital, Latina, Italy. ritadirosa728@gmail.com

(c) Division of Cardiology, Santa Maria Goretti Hospital, Latina, Italy. marco.petrassi@hotmail.it

(d) Division of Cardiology, Santa Maria Goretti Hospital, Latina, Italy. m.mastroluca@ausl.latina.it

(e) Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy. giuseppe.biondizoccai@uniroma1.it

(f) Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy.

(g) Division of Cardiology, Santa Maria Goretti Hospital, Latina, Italy. francescoversaci@yahoo.it

Correspondence to: Dr. Anna Sirignano, Division of Cardiology, Santa Maria Goretti Hospital, Via Lucia Scaravelli, 04100 Latina, Italy. Email: an.sirignano@gmail.com.


Abstract

Takotsubo cardiomyopathy is a cardiac syndrome described as a typical form of non-ischemic acute transient left ventricular dysfunction usually associated with a stressful event. We hereby report the case of an 85-year-old frail woman with 2:1 atrio-ventricular nodal block who underwent isoprenaline infusion and permanent pacemaker implantation. After the procedure, she developed an acute left ventricular impairment with typical apical ballooning, not documented on preoperative echocardiography, in the absence of coronary artery stenosis shown on coronary angiography. The patient was treated with conventional heart failure therapy and completely recovered, confirming our clinical hypothesis. Pre-existing factors on one hand and emerging factors on the other could have favored an anomalous, both endogenous and exogenous, catecholamine release, which could have contributed to precipitate this syndrome. Takotsubo cardiomyopathy should be considered as a rare, but potential complication following permanent pacemaker implantation, that has to be kept in mind by clinicians in order to apply the right diagnostic-therapeutic strategy.

Declarations

Acknowledgement

The patient described in this case report signed a pertinent written informed consent form. This manuscript was revised with the assistance of artificial intelligence tools, including ChatGPT 4 (OpenAI, San Francisco, CA, USA), in keeping with established best practices (Biondi-Zoccai G, editor. ChatGPT for Medical Research. Torino: Edizioni Minerva Medica; 2024). The final content, including all conclusions and opinions, has been thoroughly revised, edited, and approved by the authors. The authors take full responsibility for the integrity and accuracy of the work and retain full credit for all intellectual contributions. Compliance with ethical standards and guidelines for the use of artificial intelligence in research has been ensured.

Conflict of Interest

Giuseppe Biondi-Zoccai has consulted for Abiomed, Advanced Nanotherapies, Aleph, Amarin, Balmed, Cardionovum, Crannmedical, Endocore Lab, Eukon, Guidotti, Innovheart, Meditrial, Menarini, Microport, Opsens Medical, Terumo, and Translumina, outside the present work. All other authors report no conflict of interest.

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