Delayed-Onset Life-Threatening Takotsubo Cardiomyopathy Following Pulsed-Field Ablation.

BACKGROUND

Pulsed-field ablation (PFA) is a novel nonthermal modality for atrial fibrillation ablation. Takotsubo cardiomyopathy (TTC) is associated with autonomic dysregulation, but its relationship with PFA remains unclear.

CASE SUMMARY: A 62-year-old man underwent redo PFA including pulmonary vein, posterior wall, and superior vena cava isolation. The procedure was uneventful. Three hours later, he developed bradycardia, QT prolongation, and ventricular arrhythmia with cardiac arrest. Coronary angiography excluded obstructive disease, and ventriculography demonstrated apical ballooning consistent with TTC. Mechanical circulatory support led to full recovery.

DISCUSSION: This case suggests delayed-onset TTC after PFA, possibly related to autonomic imbalance rather than direct myocardial injury.

TAKE-HOME MESSAGES: Delayed life-threatening complications may occur after PFA. Postprocedural monitoring and readiness for rapid hemodynamic support are essential.