Takotsubo Syndrome Following Catheter Ablation for Atrial Fibrillation: A Systematic Review and Metasummary of Case Reports/Series

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Atrial fibrillation (AF) catheter ablation is safe and effective, though rare cases of takotsubo syndrome (TTS) have been observed without proven causation. This review synthesizes TTS following AF ablation case reports and series. Until October 2024, PubMed/Medline, SCOPUS, and Google Scholar were searched for AF ablation and TTS case reports and series. This study examines TTS incidence, clinical features, and prognosis after AF catheter ablation. Thirteen articles detailing 18 patients were included in the review. The study population had a mean age of 65 ± 9.18 years and 77.77% were female. Of the 18 patients, 6 patients (33.3%) underwent radiofrequency catheter ablation and 5 patients (27.7%) underwent cryoablation. All the patients developed TTS within 4 days of the procedure. Heart palpitations and breathlessness are predominant symptoms. Eight patients had T-wave inversion. Dyskinesia was the most prevalent echocardiography finding among the reported cases. Left ventricular ejection fraction was moderately reduced in 5 cases (35.7%) and severely reduced (left ventricular ejection fraction <30%) in 6 cases (42.8%). Of the 15 patients in whom a pattern of ballooning was reported, 13 patients had apical ballooning and 2 had atypical ballooning pattern. Of the 8 cases (44.44%) with complications, 1 had ventricular fibrillation and 2 patients had pulseless electrical activity. Left ventricular function is completely recovered among 17 patients whereas one patient died due to numerous cardiac electromechanical dissociation events. This systematic investigation highlights the need for TTS vigilance after AF ablation, especially in postmenopausal women having catheter ablation. More research is required to fully understand the prevalence, etiology, and risk factors of TTS after AF ablation.

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