A case of torsades de pointes due to takotsubo cardiomyopathy after common atrial flutter ablation

  • Author Footnotes
    ⁎ Corresponding author at: Yoichiro Nakagawa, Ishikawa Prefectural Central Hospital, Department of Cardiology, 2-1 Kuratsuki Higashi, Kanazawa City, Ishikawa Prefecture, Japan.
    Yoichiro Nakagawa
    Footnotes
    ⁎ Corresponding author at: Yoichiro Nakagawa, Ishikawa Prefectural Central Hospital, Department of Cardiology, 2-1 Kuratsuki Higashi, Kanazawa City, Ishikawa Prefecture, Japan.
    Affiliations
    Ishikawa Prefectural Central Hospital, Department of Cardiology, 2-1 Kuratsuki Higashi, Kanazawa City, Ishikawa Prefecture, Japan
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  • Hiroshi Furusho
    Affiliations
    Ishikawa Prefectural Central Hospital, Department of Cardiology, 2-1 Kuratsuki Higashi, Kanazawa City, Ishikawa Prefecture, Japan
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  • Yusuke Kamiya
    Affiliations
    Ishikawa Prefectural Central Hospital, Department of Cardiology, 2-1 Kuratsuki Higashi, Kanazawa City, Ishikawa Prefecture, Japan
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  • Ryo Nishikawa
    Affiliations
    Ishikawa Prefectural Central Hospital, Department of Cardiology, 2-1 Kuratsuki Higashi, Kanazawa City, Ishikawa Prefecture, Japan
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  • Kenji Miwa
    Affiliations
    Ishikawa Prefectural Central Hospital, Department of Cardiology, 2-1 Kuratsuki Higashi, Kanazawa City, Ishikawa Prefecture, Japan
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  • Toshihiko Yasuda
    Affiliations
    Ishikawa Prefectural Central Hospital, Department of Cardiology, 2-1 Kuratsuki Higashi, Kanazawa City, Ishikawa Prefecture, Japan
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  • Author Footnotes
    ⁎ Corresponding author at: Yoichiro Nakagawa, Ishikawa Prefectural Central Hospital, Department of Cardiology, 2-1 Kuratsuki Higashi, Kanazawa City, Ishikawa Prefecture, Japan.
Published:November 25, 2021DOI:https://doi.org/10.1016/j.jccase.2021.11.001

      Abstract

      Takotsubo cardiomyopathy (TCM) is a transient acute cardiac disorder often associated with QT prolongation, but this rarely leads to torsades de pointes (TdP). Additionally, it is a rare complication of catheter ablation. Here we report a case of TCM that developed after catheter ablation for common atrial flutter, which led to TdP.
      The patient was an 85-year-old male who had persistent supraventricular tachycardia, which was considered atrial flutter. The patient was hospitalized for congestive heart failure. Although the response to diuretic administration was unfavorable, heart failure improved with the combined use of rate control by landiolol. Catheter ablation was performed because of the possibility of tachycardia-induced cardiomyopathy. Tachycardia disappeared following ablation to the cavotricuspid isthmus, but the patient complained of severe pain during the ablation. Approximately 2 h after the treatment, the patient's heart failure re-exacerbated. The next day, electrocardiogram confirmed a marked QT prolongation, and TdP occurred.
      Although the phenomenon we experienced is rarely reported, it should be considered a complication following catheter ablation. Adequate analgesia, care for anxiety about treatment, and evaluation of cardiac condition after treatment are considered important.

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