|Home | About | Journals | Submit | Contact Us | Français|
To the Editor;
I read with interest the case report by Kodama et al (1) regarding two patients who presented with takotsubo cardiomyopathy (TC) and high-degree atrioventricular (AV) block.
Both patients were women in their fourth and fifth decades of life. Both resolved their wall-motion abnormalities within weeks, but their conduction disorders persisted. In both cases, a permanent pacemaker was implanted.
Unfortunately, the authors did not report on the follow-up of these very interesting cases to determine whether the conduction disorder was permanent or whether it had resolved over time.
It would also be very interesting to know whether forced right ventricular pacing reinduced the typical wall-motion abnormalities usually seen in TC (2).
Our group has published, to the best of our knowledge, the first case of TC associated with persistent high-degree AV block and ventricular arrhythmias (3). The electro-physiological study showed 2:1 infrahisian block, and a VDD pacemaker was implanted. The patient was a woman in her sixth decade of life. At one year follow-up, the patient remained in 2:1 AV block without any evidence of wall-motion abnormalities. After two years of follow-up, the patient was conducting 1:1, and she performed a stress test that did not induce any conduction disorder.
The physiopathology of TC remains unclear, as does the involvement of the conduction system. Is the conduction system primarily involved or does it suffer the consequence of an acutely distorted cardiac architecture?
It seems that the remodelling of the ventricle after the acute TC phase recovers within weeks, while the conduction system may take years to recover. Being aware of this clinical situation may help in reprogramming pacemakers during the follow-up to avoid unnecessary pacing.