Key result
Synchronized direct current cardioversion was associated with Takotsubo syndrome predominantly in elderly females (91%, mean age 76 years), with most cases achieving complete recovery within a median of 7 days.
Why the study?
Takotsubo syndrome has been rarely described following direct current cardioversion, and the literature was reviewed to better understand its risks.
Systematic Review (n=11)
Cardioversion-associated Takotsubo syndrome is a rare but severe complication predominantly affecting elderly females, often presenting with cardiogenic shock or pulmonary edema but generally having a favorable recovery.
Clinicians should monitor elderly females for Takotsubo syndrome after cardioversion; this review extends awareness of a rare, usually reversible complication.
Direct current cardioversion is a well-established and safe procedure to restore normal sinus rhythm for atrial and ventricular arrhythmias. Takotsubo syndrome has been rarely described with cardioversion. We reviewed the literature for descriptions of Takotsubo syndrome associated with the stress of cardioversion, to better understand its risks. We queried MEDLINE, EMBASE, Google Scholar and Cochrane for cases of Takotsubo syndrome secondary to synchronized cardioversion as defined by Mayo Clinic Diagnostic Criteria. We identified 11 cases of cardioversion-associated Takotsubo syndrome. Average age was 76 years (range: 61–87 years) and most (10 out of 11, 91%) were female. Diagnosis was made soon after cardioversion (median: 10 h, range: 0–48 h). Only 2 of 11 had ST elevations noted, while apical ballooning was noted in all cases. Pulmonary edema developed in 6 and cardiogenic shock developed in 5 patients. The median recovery time was 7 days (range: 3–11). Cardioversion-associated TS has an overall favorable outcome with complete recovery in most cases. A higher risk of this complication may exist for elderly females undergoing synchronized cardioversion.
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Waheed et al. (2022) conducted a systematic review in Takotsubo syndrome (n=11). Synchronized direct current cardioversion was evaluated. Synchronized direct current cardioversion was associated with Takotsubo syndrome predominantly in elderly females (91%, mean age 76 years), with most cases achieving complete recovery within a median of 7 days.
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