Could Esmolol/Landiolol Infusion During Pulsed Field Ablation of Atrial Fibrillation Have Averted Takotsubo Syndrome?

John E. Madias

doi:10.1016/j.jaccas.2026.107634

April 1, 2026JACC Case ReportsOpen Access

Could Esmolol/Landiolol Infusion During Pulsed Field Ablation of Atrial Fibrillation Have Averted Takotsubo Syndrome?

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Why the study?

Does periprocedural esmolol or landiolol infusion prevent takotsubo syndrome in high-risk patients undergoing pulsed field ablation of atrial fibrillation and other electrophysiology procedures?

Structured PICO

Does periprocedural esmolol or landiolol infusion prevent takotsubo syndrome in high-risk patients undergoing pulsed field ablation of atrial fibrillation and other electrophysiology procedures?

P

Population

Patients undergoing pulsed field ablation (PFA) of atrial fibrillation (AF) and other electrophysiology procedures (EPP), with a proposed target population including elderly/postmenopausal women, patients with neurological/psychiatric diseases on psychotropic drugs, those with thyroid diseases, or those excessively nervous or showing tachycardia/hypertension and decreased heart rate variability.

I

Intervention

Periprocedural carefully titrated infusions of short-acting (esmolol: 9 minutes half-life) or ultrashort-acting (landiolol: 4 minutes half-life) beta-blockers

O

Outcome

Prevention of takotsubo syndrome (TTS)

Limitations

The proposed use of periprocedural beta-blockade constitutes a hypothesis requiring validation
Beta-blockade may not prevent TTS emergence if other inciting factors (eg, microvascular dysfunction, direct cardiotoxic mechanisms) are at play
The baseline incidence of TTS during AF ablation and the specific target population have not been determined
A comparison of AF ablation employing thermo-/cryo-ablation or PFA has not been attempted

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Implication

This editorial hypothesizes that periprocedural infusion of short- or ultrashort-acting beta-blockers (esmolol or landiolol) may prevent takotsubo syndrome in high-risk patients undergoing pulsed field ablation for atrial fibrillation.

Abstract

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Cite This Study

John E. Madias (2026) studied this question.

synapsesocial.com/papers/6a025e1693868c48f30938e7 https://doi.org/10.1016/j.jaccas.2026.107634

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Could Esmolol/Landiolol Infusion During Pulsed Field Ablation of Atrial Fibrillation Have Averted Takotsubo Syndrome?

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Could Esmolol/Landiolol Infusion During Pulsed Field Ablation of Atrial Fibrillation Have Averted Takotsubo Syndrome?

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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