Takotsubo cardiomyopathy in the presence of right ventricular apical pacing: A case report

In Takotsubo cardiomyopathy (TCM), ST‐segment elevation, T‐wave inversion, and QTc prolongation are the most common electrocardiography (ECG) findings during acute and subacute periods. Right ventricular apical (RVA) pacing produces a left ventricular electrical activation sequence resembling a left bundle‐branch block, and the ST–T segment changes are usually discordant from the QRS complex. Several cases have reported that abnormal ECG manifestations in TCM could be detected even in patients with a paced ventricular rhythm. However, ECG manifestations in TCM have not been well characterized in patients with RVA pacing. Here, we report a case of a 76‐year‐old woman with RVA pacing who was diagnosed with TCM after she experienced acute bronchitis. To the best of our knowledge, this is a rare case, showing that significant QTc prolongation and concordant T‐wave inversions during full RVA pacing were longer and deeper when compared with ECG findings in past reports. The ECG findings eventually improved with a similar course as those in TCM patients without RVA pacing.