Key result
Pulsed field ablation can trigger transient Takotsubo syndrome with intraprocedural ST-segment elevation and LV dysfunction.
Case Report (n=1)
Pulse field ablation for atrial fibrillation can trigger Takotsubo syndrome, highlighting the need for vigilant intraoperative monitoring of electrocardiography and cardiac function.
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May prompt closer intraprocedural ECG monitoring during pulsed field ablation; single case leaves open true incidence and risk factors.
BACKGROUND: Takotsubo syndrome (TTS) is triggered by emotional or physical stress and characterized by transient left ventricular wall motion abnormalities in the absence of coronary culprit lesion. CASE SUMMARY: A 76-year-old woman underwent pulse field ablation (PFA) for paroxysmal atrial fibrillation. While ST-segment elevation and cardiac dysfunction were observed during the procedure, emergent coronary angiography showed no significant stenosis. The following day, left ventricular wall motion was almost normalized with T-wave inversion and prolonged QT interval. She was diagnosed with TTS due to PFA and had a favorable course with conservative treatment. DISCUSSION: This is the first report of TTS after pulmonary vein isolation with PFA. We hypothesize that it may result from stimulating sympathetic nerves caused by diaphragmatic contraction, myocardial injury, and ganglionated plexi modification according to PFA. TAKE-HOME MESSAGE: TTS should be recognized as a PFA complication, suggesting the importance to assess the intraoperative electrocardiography changes and cardiac function.
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Tomura et al. (2025) conducted a case report in Takotsubo syndrome following paroxysmal atrial fibrillation treatment (n=1). Pulse field ablation was evaluated. Pulse field ablation can trigger Takotsubo syndrome, presenting with intraprocedural ST-segment elevation and left ventricular dysfunction that fully resolves with conservative treatment.
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