Atrial arrhythmias in Takotsubo cardiomyopathy: Incidence, predictive factors and prognosis

Background Takotsubo cardiomyopathy (TTC) is a stress transient reversible cardiomyopathy mimicking acute myocardial infarction. Atrial fibrillation (AF) is the most common arrhythmia in TTC. It is not clear whether TTC is associated with poorer prognosis when AF occurs and little is known about the impact of atrial arrhythmias (AA) on mortality. The purpose of our study was to assess in a large cohort of TTC patients the incidence, management and outcome of AA, their predictive factors and impact on mortality. Methods and results We studied 214 TTC cases over 8 years. Mean follow-up was 700 ± 656 days. AA occurred in 24.8% of the patients. The cohort was divided into two groups on the basis of newly diagnosed presence or absence of AA. AA group presented lower LVEF on admission and more cardiac arrest. Admission and peak levels of troponin, BNP, CRP, leucocytes were higher in the AA group. In-hospital events were also more frequent. In-hospital, 30-day, cardiovascular and all-cause mortality were significantly higher in the AA group. Independent predictors of newly diagnosed AA were troponin peak (OR 1.03 [1.003–1.06], P  = 0.029), CRP peak (OR 1.006 [1.001–1.01], P  = 0.026) and LVEF on admission (OR 0.96 [0.93–0.99], P  = 0.01). BNP peak (OR 1.00 [1.000–1.001], P  = 0.022) and leukocytes peak (OR 1.095 [1.034–1.16], P  = 0.002) were predictive factors of in-hospital mortality. LVEF at the end of hospitalization (OR 0.935 [0.899–0.972], P  = 0.001) and leukocytes peak (OR 1.068 [1.000–1.139], P  = 0.049) were predictive factors of cardiovascular death ( Fig. 1 ). Conclusion New onset of atrial arrhythmia is frequent in patients presenting with TTC and is associated with a worsened short and long-term prognosis of this cardiomyopathy. Acute and transient inflammation and myocardial damage are predictors of atrial arrhythmia. Inflammation and resulting left ventricular ejection fraction are predictors of cardiovascular mortality.