Takotsubo syndrome following radiofrequency ablation of atrial fibrillation in a patient with coronary artery anomaly: a case report

BACKGROUND: Takotsubo syndrome (TTS) is an acute heart failure syndrome usually induced by emotional or physical stress. The prevalence of TTS seems to be higher than previously anticipated. Radiofrequency catheter ablation could be a rare trigger of TTS. The pathophysiology is not fully understood. Sympathetic stimulation plays an important role on the development of TTS. CASE SUMMARY: A 62-year-old woman was referred for RFCA because of drug-refractory symptomatic paroxysmal atrial fibrillation. No other chronic diseases were stated except for a hypertension history. Three hours after the AF ablation, the patient complained of chest pain. New electrocardiographic abnormalities were presented including progressive T-wave inversion and significant QT prolongation. Multimodality imaging, including echocardiography, coronary angiography, left ventriculography, and computed tomography was conducted in establishing the TTS diagnosis. The congenital coronary artery anomaly was confirmed at the same time. Both transthoracic echocardiography and left ventriculography showed typical TTS changes. Elevation of the brain natriuretic peptide and Troponin I was observed during the acute phase. Angiotensin-converting enzyme inhibitor and β-blocker were administrated during hospitalization and after discharge. Two weeks later, echocardiography and cardiovascular magnetic resonance revealed a total recovery of left ventricular function and apex kinesis. DISCUSSION: Sometimes, it is hard to distinguish TTS from acute coronary syndrome because of similar manifestations. Multimodality imaging is helpful to confirm the diagnosis. Radiofrequency catheter ablation could be a rare trigger of TTS, and its incidence may increase in patients with coronary artery anomaly. Coronary spasm and increased cardiac sympathetic activity induced by the ablation might be the mechanism involved.