Takotsubo Syndrome Following Pulmonary Vein Isolation With Pulse Field Ablation.

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.