Serious arrhythmias occurred in 6.2% of Takotsubo syndrome patients, but their association with higher crude in-hospital mortality disappeared after adjusting for confounders (OR 1.15; 95% CI 0.90-1.49).
Cohort (n=16,713)
Yes
Does the occurrence of serious arrhythmias independently increase in-hospital mortality in patients hospitalized for Takotsubo syndrome?
Serious arrhythmias occur in 6.2% of Takotsubo syndrome patients but are not independently associated with increased in-hospital mortality after adjusting for baseline confounders, suggesting some device implantations for these potentially reversible arrhythmias may be unnecessary.
Effect estimate: OR 1.15 (95% CI 0.90-1.49)
Absolute Event Rate: 9.6% vs 5%
p-value: p=<0.001
AIMS: Arrhythmia is a major complication of Takotsubo syndrome (TTS). However, its incidence, management, and prognostic impact remain to be elucidated in a large cohort. METHODS AND RESULTS: We retrospectively identified 16 713 patients hospitalized for TTS between July 2010 and March 2021 from the Japanese Diagnosis Procedure Combination database. Serious arrhythmias were defined as ventricular tachycardia/fibrillation (VT/VF), 2nd-/3rd-degree atrioventricular block (AVB), sick sinus syndrome (SSS), or unspecified arrhythmias requiring device treatment. Patient characteristics and outcomes were compared based on the occurrence of serious arrhythmias. The overall incidence proportion of serious arrhythmias was 6.2% (n = 1036; 449 VT/VF, 283 2nd-/3rd-degree AVB, 133 SSS, 55 multiple arrhythmias, 116 others), which remained stable over 11 years. The arrhythmia group was younger, more often male, and exhibited greater impairment in activities of daily living (ADLs) and consciousness than the non-arrhythmia group. Although crude in-hospital mortality was higher in the arrhythmia group (9.6% vs. 5.0%, P < 0.001), the significant association between arrhythmias and mortality disappeared after adjustment for confounders (odds ratio = 1.15, 95% confidence interval = 0.90-1.49). Meanwhile, age, sex, ADLs, consciousness level, and Charlson comorbidity index were significantly associated with mortality. In the arrhythmia group, 254 (24.5%) patients received pacemakers (18.4%) or defibrillators (6.1%), which were implanted at a median of 8 and 19 days after admission, respectively. CONCLUSION: Arrhythmias are not uncommon in TTS. Patients' background characteristics, rather than arrhythmia itself, may be associated with in-hospital mortality. Given the reversibility of cardiac dysfunction in TTS, there may be unnecessary device implantations for arrhythmias occurring as sequelae to TTS, warranting further investigations.
Isogai et al. (Fri,) conducted a cohort in Takotsubo syndrome (n=16,713). Serious arrhythmias vs. No serious arrhythmias was evaluated on In-hospital mortality (OR 1.15, 95% CI 0.90-1.49, p=<0.001). Serious arrhythmias occurred in 6.2% of Takotsubo syndrome patients, but their association with higher crude in-hospital mortality disappeared after adjusting for confounders (OR 1.15; 95% CI 0.90-1.49).