Broken hearts, broken rhythms: the hidden arrhythmic risk in takotsubo syndrome

Abstract Introduction Tako-tsubo syndrome is characterized by acute transient left ventricular (LV) dysfunction that can mimic acute coronary syndrome (ACS). This analysis was performed to evaluate the frequency of rythm disorders, analyze the most common arrhythmias and conduction disorders, and assess the risk factors and complications presented by patients who develop conduction disorders during hospitalization and follow-up. Methods This is a retrospective registry of patients diagnosed with Tako-tsubo syndrome in the community of Cantabria between 2012 and 2023, with a median follow-up of 5.5 years. Patients who met the modified Mayo criteria were selected. Quantitative variables are expressed as mean and standard deviation, and qualitative variables are expressed as number and percentage. Fisher's exact test or Chi-square test was used for qualitative variables, and Student's t-test was used for quantitative variables. Results A total of 330 patients were included. Of the total number of patients, females predominated (75%) with a mean age of 70 years. In the group with conduction disorders/arrhythmias, we found a total of 45 patients, representing 13.6% of the sample. The most frequent arrhythmias were supraventricular (atrial fibrillation or flutter) in 63% of patients. These were followed by polymorphic ventricular tachycardia (VT)/ventricular fibrillation and complete block (both 14%) and finally monomorphic VT with 9%. The characteristics of the patients are summarized in Table 2. Among the clinical characteristics, there were no differences in age or cardiovascular risk factors, but emotional triggers were significantly more frequent. In terms of outcome, patients with arrhythmias had significantly more complications and mortality during their hospital stay. Conclusion Conduction disorders in patients with Tako-Tsubo syndrome are not uncommon, mainly in the form of supraventricular arrhythmias in patients with medical triggers. Complications and mortality are not negligible, and the results are consistent with previous studies. However, this study has limitations due to the number of patients included and the fact that it is a retrospective observational study.