Provocative Cases -> Teaching Case Reports D-PO01 - Featured Poster Session (ID 11) Poster

D-PO01-117 - A Case Of Severe Takotsubo Syndrome Secondary To A One-stage Intervention Combining Catheter Ablation And Left Atrial Appendage Occlusion (ID 104)

 Y. Zhou: Nothing relevant to disclose.


Background: Takotsubo syndrome (TTS) is characterized by temporary left ventricle (LV) apical ballooning typically triggered by emotional or physical stressors.
Objective: We describe a rare case of TTS that developed after a one-stage intervention combining ablation and left atrial appendage occlusion (LAAO) for the treatment of persistent atrial fibrillation (AF).
Results: 70 y/o female was referred to our center for redo ablation of persistent AF. Regarding high CHA2DS2-VASc and HAS-BLED scores (7 and 4, respectively), she underwent a one-stage procedure combining ablation and LAAO, which was performed successfully (Fig.1A). Thirty minutes later, however, the patient complained of chest pain and nausea. ECG showed ST-segment elevations in leads V3-V6, II, III and aVF (Fig.1B), with a mild elevated troponin I concentration. Emergency coronary angiography yielded unremarkable findings (Fig.1C). Over the following 2 days, the patient developed profound hypotension and paroxysmal ventricular arrhythmias, all of which were managed uneventfully. On day 3, transthoracic echocardiography (TTE) revealed akinesia in the apical areas and a hypercontractile basal segment with a left ventricular ejection fraction of 55% (Fig.1D), which confirmed the diagnosis of TTS. On day 14, the patient was free of symptoms, but ECG showed T-wave inversion in leads V3-V6 (Fig.1E). TTE depicted improvement in LV wall motion abnormalities before discharge. The abnormal ECG and TTE features resolved at the 3-month follow-up (Fig.1F).
Conclusion: Severe TTS is a possible complication of the one-stage procedure combining ablation and LAAO for the treatment of AF.