Complete atrioventricular block associated with takotsubo cardiomyopathy.
An 82-year-old woman was admitted to the hospital due to repeated episodes of syncope with incontinence. Electrocardiography showed torsades de pointes, complete atrioventricular (AV) block, T-wave inversions and a prolonged QTc interval. Urgent coronary angiography showed no significant coronary stenosis and left ventriculography demonstrated typical abnormal wall motion of takotusbo cardiomyopathy. Electrophysiology study suggested that the damaged structure might be the bundle of His. After temporary transvenous pacing and administration of intravenous lidocaine, no recurrence of torsade de pointes was found. Symptoms of worsening heart failure were not found. Although abnormal left ventricular wall motion improved, a complete AV block remained and the patient needed pacemaker implantation on Day 18 after admission. This case demonstrated that complete AV block associated with takotsubo cardiomyopathy may persist after improvement of left ventricular wall motion, and implantation of a pacemaker may be needed.
Inoue
Masaru
M
Division of Cardiology, Ishikawa Prefectural Hospital, 2-1 Kuratsuki-Higashi, Kanazawa 920-8530, Japan. cardioheart1143729b@yahoo.co.jp
Kanaya
Honin
H
Matsubara
Takao
T
Uno
Yoshihide
Y
Yasuda
Toshihiko
T
Miwa
Kenji
K
D000369:Aged, 80 and over; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage; D004562:Electrocardiography; D005260:Female; D006327:Heart Block / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage; D010138:Pacemaker, Artificial; D015635:Radionuclide Ventriculography; D054549:Takotsubo Cardiomyopathy / Q000150:complications* / Q000000981:diagnostic imaging; D016171:Torsades de Pointes / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology
D000889:Anti-Arrhythmia Agents; D008012:Lidocaine