Impact of left bundle branch block in Takotsubo Syndrome
Jose Lopez1, Gustavo J Duarte2, Rosario A Colombo3
1Department of Internal Medicine, HCA Florida Aventura Hospital, Aventura, FL, United States.
Insights
Left bundle branch block (LBBB) in takotsubo syndrome (TTS) patients is linked to increased ventricular arrhythmias but not sudden cardiac arrest or mortality. This suggests dyssynchrony may drive arrhythmias in TTS.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiomyopathy
Background:
- Left bundle branch block (LBBB) exacerbates left ventricular dysfunction and dyssynchrony.
- Takotsubo syndrome (TTS) is a form of cardiomyopathy often mimicking myocardial infarction.
- The combined impact of LBBB and TTS on in-hospital outcomes requires further investigation.
Purpose of the Study:
- To investigate the association between LBBB and in-hospital outcomes in patients diagnosed with TTS.
- To determine if LBBB independently influences adverse events in TTS patients.
Main Methods:
- Utilized the National Inpatient Sample (NIS) database from 2016-2019.
- Identified TTS admissions using ICD-10 codes.
- Employed multivariate regression analysis to assess LBBB's effect on outcomes.
Main Results:
- Analyzed 26,615 TTS admissions; LBBB patients were older with more comorbidities.
- LBBB presence was significantly associated with ventricular arrhythmias (OR=1.97, p=0.028).
- No significant association was found between LBBB and sudden cardiac arrest, acute heart failure, cardiogenic shock, or in-hospital mortality.
Conclusions:
- Intraventricular dyssynchrony, potentially exacerbated by LBBB, may contribute to ventricular arrhythmogenesis in TTS.
- Elevated catecholamines are a likely mechanism for arrhythmia development in TTS.
- LBBB appears to increase the risk of ventricular arrhythmias in TTS patients.
Background:
Left bundle branch block (LBBB) causes left ventricular dyssynchrony, and its presence with concomitant left ventricular dysfunction has been proven to play a synergistic role, worsening ventricular function. Our study seeks to further explore the association between LBBB and various in-hospital outcomes in patients with takotsubo syndrome (TTS).
Methods:
The national inpatient sample was queried from 2016 to 2019 to identify all admissions with a primary diagnosis of TTS. International classification of diseases, tenth revision codes were used to divide patients based on the presence or absence of LBBB. Multivariate regression analysis was performed to assess the effect of LBBB among all the pre-specified outcomes.
Results:
A total of 26,615 admissions were included in the analysis. Admissions with LBBB were more likely to be older (72.2 vs. 66.2 years) and have a higher burden of comorbidities. The presence of a LBBB was associated with ventricular arrhythmias (OR = 1.97, 95% CI 1.08-3.61, p = 0.028) but not with sudden cardiac arrest (SCA), acute heart failure, cardiogenic shock, and all-cause intra-hospital mortality.
Conclusions:
Intraventricular dyssynchrony appears to play a significant role in ventricular arrhythmogenesis and SCA, as several trials have demonstrated that cardiac resynchronization therapy alone without defibrillator function reduces the rate of ventricular arrhythmias and SCA in patients with heart failure with systolic dysfunction and a widened QRS complex. The most likely mechanism of arrhythmia development in TTS is related to the elevated plasma levels of catecholamines and their proarrhythmic effects in the ventricular myocardium.
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