Key result
Life-threatening arrhythmias in Takotsubo cardiomyopathy are linked to ~3-fold higher in-hospital mortality.
Why the study?
Does the presence of life-threatening arrhythmias increase mortality and cardiogenic shock in patients with Takotsubo cardiomyopathy?
Meta-Analysis (n=72,698)
Does the presence of life-threatening arrhythmias increase mortality and cardiogenic shock in patients with Takotsubo cardiomyopathy?
Answers are grounded in this paper and cite their sources.
Life-threatening arrhythmias occur in approximately 7% of Takotsubo cardiomyopathy patients and are associated with a nearly three-fold increase in in-hospital mortality and a significantly higher risk of cardiogenic shock.
Background: Takotsubo cardiomyopathy (TCM) is an acute stress-induced condition that mimics acute coronary syndrome. Once considered benign, emerging evidence highlights a significant risk of life-threatening arrhythmias in TCM, underscoring the need to better define its incidence, predictors, and outcomes. Objectives: This meta-analysis synthesizes all available evidence on the incidence and subtypes of life-threatening arrhythmias (LTA) in Takotsubo cardiomyopathy. We further assess clinical outcomes, including cardiogenic shock, mortality, and device-based therapy needs. Methodology: We systematically searched PubMed, Cochrane Library, Embase, and Scopus, identifying 2,781 studies, of which 22 met the inclusion criteria (72,698 patients; ≥18 years, reporting LTA incidence in TCM). Statistical analysis was performed in R (Version 2024.12.0+467) using the "meta" with a significance threshold of P < 0.05. Results: The pooled prevalence of life-threatening arrhythmias (LTA) was 7% (95% CI: 5–11%, I2 = 99.6%). Among specific arrhythmias, ventricular tachycardia had the highest prevalence (43%, 95% CI: 24–65%, I2 = 97.7%), followed by ventricular fibrillation (29%, 95% CI: 18–43%, I2 = 98.8%), complete atrioventricular block (27%, 95% CI: 25–30%, I2 = 15.8%), Torsade de Pointes (22%, 95% CI: 5–60%), and asystole (19%, 95% CI: 11–29%). The apical, inverted, and apical sparing variants of Takotsubo cardiomyopathy showed no significant association with LTA risk. Sudden cardiac death risk was markedly increased (RR 14.92, 95% CI: 3.49–63.75, I2= 57.1%). LTA was linked to higher in-hospital mortality (RR 2.94, 95% CI: 1.78–4.86, I2 = 67.3%) and cardiogenic shock (RR 3.72, 95% CI: 2.62–5.28). Long-term mortality showed no significant difference. Comorbidities had no significant association. Among patients with LTA, permanent pacemaker placement was required in 18% (95% CI: 16–20%, I2 = 0%), while temporary pacing was needed in 14% (95% CI: 12–16%, I2 = 34.4%). Conclusion: LTA was associated with high mortality and intervention rates, underscoring the importance of early risk stratification, while Takotsubo variants and comorbidities lacked significance.
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Malik et al. (2025) conducted a meta-analysis in Takotsubo cardiomyopathy (n=72,698). Life-threatening arrhythmias vs. No life-threatening arrhythmias was evaluated on In-hospital mortality (RR 2.94, 95% CI 1.78-4.86). Life-threatening arrhythmias occurred in 7% of Takotsubo cardiomyopathy patients and were associated with increased risks of sudden cardiac death (RR 14.92) and in-hospital mortality (RR 2.94).
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