Takotsubo syndrome presenting as ventricular fibrillation cardiopulmonary arrest coupled with complete heart block

Life-threatening arrhythmia can occur in patients with takotsubo syndrome (TTS). However, it is unusual for a TTS patient to present with ventricular fibrillation cardiopulmonary arrest (VF-CPA) coupled with complete heart block at the initial presentation. An 83-year-old woman underwent a VF-CPA. After she was successfully defibrillated, her electrocardiogram showed deep T-wave inversions with unusually prolonged QT-intervals (QTc = 0.493) at leads V1-V6 together with complete heart block. Echocardiogram and left ventriculogram showed broad ballooning from the mid left ventricle (LV) to the apex, consistent with TTS. A repeated echocardiogram 11 days after the VF-CPA event showed total recovery of the LV wall motion. She later testified that she had experienced slow pulse rate 3 days prior to the event. In conclusion, TTS presenting as VF-CPA as well as complete heart block is most unusual. As a possible sequence of events, it is postulated that TTS triggered by complete heart block was followed by VF-CPA. Prominent post-TTS QT prolongation, partly influenced by complete heart block, is considered as a possible mechanism for the VF-CPA event in this TTS patient.

Although life-threatening arrhythmia can occur in patients with takotsubo syndrome (TTS), a TTS patient presenting with ventricular fibrillation cardiopulmonary arrest (VF-CPA) together with complete heart block is most unusual. Prominent post-TTS QT prolongation, partly influenced by complete heart block, is considered as a possible mechanism for the VF-CPA event in this TTS patient. It is important to recognize that TTS may be at times triggered by complete heart block.