Takotsubo syndrome induced by de novo left bundle branch area pacing: a case report

Takotsubo syndrome (TS), traditionally associated with emotional or physical stressors, manifests as transient left ventricular (LV) abnormalities mimicking acute coronary syndrome. Surgical procedures, such as pacemaker implantation, have emerged as potential TS triggers. Conduction system pacing (CSP), including His bundle pacing and left bundle branch area pacing (LBBAP), is a novel technique utilizing the heart's intrinsic conduction system. Despite documented cases of TS post-pacemaker implantation, the literature exploring the association between CSP and TS remains sparse.

In a case involving a 62-year-old woman with 2:1 atrioventricular block, an uncomplicated de novo LBBAP procedure was followed by post-procedural dizziness and dyspnoea. An initial transthoracic echocardiography revealed moderate-severe LV dysfunction, accompanied by elevated troponin levels. Coronary angiography showed unobstructed coronary arteries, while left ventriculography exhibited a classic apical ballooning. The patient had a favourable recovery, with LV function improvement noted before discharge.

Takotsubo syndrome may be triggered by other non-traditional physical stressors including traditional RV pacing and LBBAP. Clinicians should be aware of this potential, albeit rare, complication of LBBAP to ensure timely recognition and management. Increased awareness is vital for optimizing patient care during CSP procedures.