Key result
Primary aldosteronism may increase Takotsubo syndrome risk after PVI for AF.
Why the study?
The association between Tako-tsubo syndrome and primary aldosteronism is not well known, and the mechanisms and risk factors of Tako-tsubo syndrome following pulmonary vein isolation remain poorly understood.
Case Report (n=1)
Tako-tsubo syndrome can occur as a rare complication following pulmonary vein isolation for atrial fibrillation, potentially exacerbated by increased sympathetic activity from primary aldosteronism.
Answers are grounded in this paper and cite their sources.
May warrant vigilance for Tako-tsubo syndrome post-PVI in primary aldosteronism; this case report leaves open causality and requires prospective validation.
Tako-tsubo syndrome (TTS) can be triggered by emotional or physical stress and is characterized by transient left ventricular dysfunction with apical ballooning. Some neurologic disorders and pheochromocytoma serve as triggers for TTS, however, its association with primary aldosteronism (PA) is not well known. Pulmonary vein isolation (PVI) with catheter ablation for atrial fibrillation (AF) has been performed worldwide, and TTS following PVI has been reported as a rare complication. Sympathetic stimulation can play an important role in TTS development, however, its mechanism and risk factors are not yet understood.We describe a 72-year-old woman with PA who developed TTS after PVI with radiofrequency catheter ablation (RFCA) for symptomatic paroxysmal AF. Complete isolation of the pulmonary vein was carried out without any complications, however, she complained of epigastric discomfort 7 hours after the procedure. An electrocardiogram showed recurrent AF with a new negative-T wave and prolonged QT interval. Transthoracic echocardiography revealed apical ballooning and basal hypercontraction, characteristic of TTS, and coronary angiography showed no significant stenosis. She was diagnosed with TTS following RFCA for AF and managed well with conservative therapy.The present case suggests that TTS should be recognized as a complication associated with AF ablation. Moreover, PA may be involved in TTS development by increasing sympathetic activity. Further studies on the mechanism and characteristics of TTS are required.
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Shoji et al. (2023) conducted a case report in Tako-tsubo syndrome, primary aldosteronism, atrial fibrillation (n=1). Pulmonary vein isolation with radiofrequency catheter ablation was evaluated. A 72-year-old woman with primary aldosteronism developed Tako-tsubo syndrome 7 hours after pulmonary vein isolation for atrial fibrillation, suggesting primary aldosteronism may increase risk.
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