Takotsubo Syndrome Presenting as ST-Elevation Myocardial Infarction With Concomitant Persistent High-Grade AV Block Requiring Cardiac Resynchronisation Therapy Pacemaker.

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Takotsubo syndrome with persistent high-grade AV block (n=1). Intervention: Cardiac resynchronisation therapy pacemaker (CRT-P).

Jhiamluka Solano; Ali Hussain; Adnan Ahmed; Raj Chelliah; Muhammad Usman Shah

doi:10.1155/cric/1482184

January 1, 2026Open Access

Takotsubo Syndrome Presenting as ST-Elevation Myocardial Infarction With Concomitant Persistent High-Grade AV Block Requiring Cardiac Resynchronisation Therapy Pacemaker.

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Key result

CRT-P resolves persistent high-grade AV block and recovers LVEF to ~50% in Takotsubo syndrome.

n=1

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Key Points

To describe the presentation, diagnosis, and device management of Takotsubo syndrome presenting as ST-elevation myocardial infarction complicated by persistent high-grade atrioventricular block.
Evaluated a postmenopausal woman presenting with light-headedness and diaphoresis with lateral ST elevation and reciprocal inferior ST depression on 12-lead ECG.
Performed emergency invasive coronary angiography, left ventriculography, biomarker testing, transthoracic echocardiography, and cardiac MRI.
Coronary angiography showed normal coronary arteries without stenosis, while left ventriculography confirmed apical ballooning with an initial LVEF of 30%–35% and troponin of 147 ng/L.
Subsequent electrocardiograms captured persistent Mobitz Type 2 second-degree AV block, right bundle branch block, and a prolonged QRS of 162 ms, leading to CRT-P implantation.
Follow-up demonstrated LVEF recovery to 50% on echocardiography and 53% on cardiac MRI, while high biventricular pacing persisted at 100% at 1 year and 99% at 4 years.

Study Design

Type

Case Report (n=1)

Structured PICO

P

Population

A middle-aged postmenopausal woman who presented with Takotsubo syndrome mimicking a STEMI and developed persistent high-grade AV block requiring a CRT-P.

I

Intervention

Implantation of a cardiac resynchronisation therapy pacemaker (CRT-P) and initiation of guideline-directed medical therapy for heart failure.

O

Outcome

Clinical stability, recovery of left ventricular systolic function, and pacing burden at follow-up.

This case highlights that while Takotsubo syndrome-associated left ventricular dysfunction typically resolves, concomitant high-grade AV block may persist, requiring permanent pacing in which CRT-P may be favorable to prevent pacing-induced cardiomyopathy.

Limitations

Causality cannot be inferred from a single case report.
Evidence on the management of Takotsubo syndrome with cardiac conduction abnormalities using a permanent pacemaker is limited to case reports, lacking standardized guidelines.
Single case report from which causality cannot be inferred
Lack of established guidelines for managing TTS with conductive tissue abnormalities

Implication

CRT-P may be considered for rare persistent AV block in Takotsubo syndrome; single case leaves open need for prospective data.

Abstract

Takotsubo syndrome (TTS), also known as stress-induced cardiomyopathy or apical ballooning syndrome, is increasingly recognised as an acute myocardial ischemic syndrome primarily involving transient microvascular dysfunction rather than epicardial coronary occlusion and characterised by transient left ventricular dysfunction. Patients are predominantly postmenopausal women and may clinically mimic acute coronary syndrome, including ST-elevation myocardial infarction (STEMI) as well as non-ST-elevation myocardial infarction (NSTEMI). While TTS may coexist with obstructive coronary artery disease (CAD), the hallmark feature is a mismatch between the severity of wall motion abnormalities and the distribution of any coronary lesions. We present a postmenopausal lady who presented as a presumed STEMI but was eventually diagnosed to have takotsubo cardiomyopathy. She developed a persistent high-grade AV block with poor ejection fraction and was subsequently implanted with a cardiac resynchronisation therapy pacemaker (CRT-P).

Discussion

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Cite This Study

Solano et al. (2026) conducted a case report in Takotsubo syndrome with persistent high-grade AV block (n=1). Cardiac resynchronisation therapy pacemaker (CRT-P) was evaluated. Implantation of a cardiac resynchronisation therapy pacemaker successfully managed persistent high-grade AV block in a patient with Takotsubo syndrome, with LVEF improving to 50% at follow-up.

synapsesocial.com/papers/69a7cc4cd48f933b5eed7f4f https://doi.org/10.1155/cric/1482184

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Takotsubo Syndrome Presenting as ST-Elevation Myocardial Infarction With Concomitant Persistent High-Grade AV Block Requiring Cardiac Resynchronisation Therapy Pacemaker.

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Takotsubo Syndrome Presenting as ST-Elevation Myocardial Infarction With Concomitant Persistent High-Grade AV Block Requiring Cardiac Resynchronisation Therapy Pacemaker.

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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