Takotsubo Syndrome in the Setting of Pacemaker Implantation: Results From a Multicenter National Prospective Registry

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Background: There is evidence that pacemaker implantation can trigger Takotsubo syndrome (TTS). However, limited information is available on the prognosis of TTS caused by this trigger, so our study aims to elucidate the clinical features, presentation, and prognostic factors associated with this syndrome in this specific situation. Methods: We analyzed a group of patients with TTS triggered by pacemaker implantation (n = 41), including consecutive cases from the multicenter registry on takotsubo syndrome (RETAKO) and patients identified through a systematic literature search, and compared them to the general RETAKO cohort (n = 1559). We performed a 1:3 propensity score matching (PSM) based on dyslipidemia, diabetes mellitus, smoker/ex-smoker status, syncope, angina, vagal symptoms, and physical/mixed trigger, generating two balanced groups. Results: Compared to other triggers, TTS associated with pacemaker implantation was linked to a longer corrected QT interval (551.2 ms vs. 502.5 ms, p = 0.005), lower left ventricular ejection fraction (34.8% vs. 47.3%, p < 0.001), a higher proportion of acute kidney injury (29.3% vs. 11.0%, p = 0.001), and an increased rate of cardiogenic shock (20.6% vs. 8.8%, p = 0.029). However, there were no differences in all-cause mortality (12.2% vs. 13.1%, p = 0.858) or TTS recurrence (0.0% vs. 3.9%, p = 0.639). After PSM, the previously observed differences were no longer present, with no significant differences in death or recurrences. Conclusions: TTS following pacemaker implantation predominantly presents with greater rates of cardiogenic shock and acute kidney injury, without differences in all-cause mortality or TTS recurrence. After PSM, no differences were found regarding cardiovascular outcomes, suggesting that the physical nature of the trigger could account for the initial differences observed.

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