Electrocardiographic abnormalities in Takotsubo cardiomyopathy: Relevance in patients with left bundle-branch block/paced ventricular rhythms
Article Outline
Dear Editor:
We read with great interest the article published by Dib et al in the June 2009 issue of the American Heart Journal.1 In this article, the authors elegantly presented the clinical correlates and prognostic significance of admission electrocardiographic (EKG) findings in a relatively large group of patients with apical ballooning syndrome (ABS). The authors mentioned that 3 patients had preexisting left bundle-branch block (LBBB), and these were grouped together with patients with normal or nonspecific EKG changes. In this context, we would like to ask: In patients with preexisting LBBB, were there any new EKG changes suggestive of myocardial ischemia compared with baseline EKG? Despite known limitations, concordant ST depression and concordant negative T waves have been shown to be indicators of infarction/ischemia in patients with LBBB.2, 3 Apical ballooning syndrome being a close mimic of acute coronary syndrome, it is probable that similar abnormalities might have clinical utility.
As in LBBB, interpreting new EKG changes is difficult in patients with right ventricular pacing. However, the authors had excluded patients with paced ventricular rhythm in their study because of underlying wall motion abnormalities. Given the increasing awareness and diagnosis of ABS, it is likely that patients with paced rhythm and features of ABS will increasingly be encountered. In our personal experience of caring for pacemaker-dependent patients diagnosed with ABS as per the Mayo clinic criteria,4 we observed concordant negative T waves in the precordial leads and QTc prolongation. These changes were noted while patients were in ventricular paced rhythm and new compared with baseline EKG, also showing ventricular paced rhythm. The EKG changes returned to baseline on follow-up in about 4 to 6 weeks. We would like to know if the authors noted similar changes in their patients with LBBB.
References
- Clinical correlates and prognostic significance of electrocardiographic abnormalities in apical ballooning syndrome (Takotsubo/stress-induced cardiomyopathy). Am Heart J. 2009;157:933–938
- AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram part III: intraventricular conduction disturbances. A scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society. J Am Coll Cardiol. 2009;53:976–981
- Barold SS, Herweg B, Curtis AB. Electrocardiographic diagnosis of myocardial infarction and ischemia during cardiac pacing. Cardiol Clin. 2006;24:387-99, ix.
- . Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction. Am Heart J. 2008;155:408–417
PII: S0002-8703(10)00239-5
doi:10.1016/j.ahj.2010.03.014
© 2010 Mosby, Inc. All rights reserved.
Refers to article:
- Clinical correlates and prognostic significance of electrocardiographic abnormalities in apical ballooning syndrome (Takotsubo/stress-induced cardiomyopathy)
