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Malignant arrhythmia in apical ballooning syndrome: risk factors and outcomes
Chadi Dib1, Abhiram Prasad, Paul A Friedman
1Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic,Rochester, Minnesota, USA.
Insights
Symptomatic arrhythmia is uncommon in apical ballooning syndrome (ABS) but carries a poor prognosis. Increased R-R interval variability may predict these dangerous arrhythmias, warranting further study of beta-blocker therapy.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiomyopathy
Background:
- Apical ballooning syndrome (ABS), also known as Takotsubo cardiomyopathy, is characterized by transient left ventricular dysfunction.
- The occurrence and impact of symptomatic arrhythmias in ABS patients are not well-defined.
Purpose of the Study:
- To determine the frequency and outcomes of symptomatic arrhythmias in patients diagnosed with apical ballooning syndrome (ABS).
Main Methods:
- Retrospective review of the Mayo Clinic Angiography database for patients meeting ABS criteria.
- Comparison of patients with documented arrhythmias (study group) against a control group of ABS patients without arrhythmias.
Main Results:
- Symptomatic arrhythmia occurred in 5.7% of ABS patients, with outcomes including death and need for permanent pacemaker.
- R-R interval variability was significantly higher in patients with arrhythmia compared to controls (30.6+/-6 vs 14.5+/-17, p=0.0004).
- Beta-blocker therapy was more common in patients without arrhythmia (80.6% vs 33%, p=0.02).
Conclusions:
- Life-threatening arrhythmias are infrequent but serious complications of ABS.
- Elevated R-R interval variability may serve as a predictor for significant arrhythmias in ABS.
- The potential protective role of beta-blocker therapy in ABS arrhythmia requires further investigation.
Objectives:
We sought to determine the frequency and outcomes with symptomatic arrhythmia in patients with apical ballooning syndrome (ABS).
Methods:
A retrospective review of the Mayo Clinic Angiography database was conducted to identify patients who met the Mayo criteria for ABS. Patients with documented arrhythmias formed the study group, and 31 randomly selected patients with ABS but without arrhythmia formed the control group.
Results:
Out of 105 patients identified with ABS, 6 (5.7%) women aged 69 +/- 9 years experienced significant arrhythmia (ventricular fibrillation, asystole), 2 patients died, and 1 required permanent pacemaker implantation. When compared with controls, the study group showed no significant difference with respect to ECG characteristics (QT, QRS duration or axis) except for R-R interval variability (see comments below) (30.6+/-6 vs 14.5+/-17 p = 0.0004), QTc, and P-R interval. Patients without arrhythmia were more likely to be on beta-blocker therapy than the study population (33% vs 80.6% p = 0.02).
Conclusion:
Life-threatening arrhythmia is uncommon (5.7%) with ABS despite marked, structural abnormalities. When arrhythmias do occur, the outcome is poor. Prominent variability in R-R intervals appears to be predictive of significant arrhythmias in ABS. The role of beta-blocker therapy in preventing arrhythmia with ABS requires further investigation.
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