AIMS: We aimed to evaluate the frequency, clinical features, and prognostic implications of cardiac arrest (CA) in takotsubo syndrome (TTS). METHODS AND RESULTS: We reviewed the records of patients with CA and known heart rhythm from the International Takotsubo Registry. The main outcomes were 60-day and 5-year mortality. In addition, predictors of mortality and predictors of CA during the acute TTS phase were assessed. Of 2098 patients, 103 patients with CA and known heart rhythm during CA were included. Compared with patients without CA, CA patients were more likely to be younger, male, and have apical TTS, atrial fibrillation (AF), neurologic comorbidities, physical triggers, and longer corrected QT-interval and lower left ventricular ejection fraction on admission. In all, 57.1% of patients with CA at admission had ventricular fibrillation/tachycardia, while 73.7% of patients with CA in the acute phase had asystole/pulseless electrical activity. Patients with CA showed higher 60-day (40.3% vs. 4.0%, P < 0.001) and 5-year mortality (68.9% vs. 16.7%, P < 0.001) than patients without CA. T-wave inversion and intracranial haemorrhage were independently associated with higher 60-day mortality after CA, whereas female gender was associated with lower 60-day mortality. In the acute phase, CA occurred less frequently in females and more frequently in patients with AF, ST-segment elevation, and higher C-reactive protein on admission. CONCLUSIONS: Cardiac arrest is relatively frequent in TTS and is associated with higher short- and long-term mortality. Clinical and electrocardiographic parameters independently predicted mortality after CA.

1st Department of Cardiology Medical University of Gdansk Gdansk Poland

1st Department of Medicine Faculty of Medicine University Medical Centre Mannheim University of Heidelberg Mannheim Germany

3rd Medical Faculty Charles University Prague and University Hospital Kralovske Vinohrady Prague Czech Republic

Center for Cardiology Cardiology 1 University Medical Center Mainz Mainz Germany

Center for Molecular Cardiology Schlieren Campus University of Zurich Zurich Switzerland

Clinic for Cardiology and Pneumology Georg August University Goettingen Goettingen Germany

Department of Cardiology and Angiology Hannover Medical School Hannover Germany

Department of Cardiology and Cardiac Imaging Center University Hospital of Rangueil Toulouse France

Department of Cardiology Charité Campus Rudolf Virchow Berlin Germany

Department of Cardiology Heidelberg University Hospital Heidelberg Germany

Department of Cardiology John Radcliffe Hospital Oxford University Hospitals Oxford UK

Department of Cardiology Kantonsspital Lucerne Lucerne Switzerland

Department of Cardiology Kantonsspital Winterthur Winterthur Switzerland

Department of Cardiology Kings College Hospital Kings Health Partners London UK

Department of Cardiology Leiden University Medical Centre Leiden The Netherlands

Department of Cardiology Medical University of Warsaw Warsaw Poland

Department of Cardiology University Heart Center University Hospital Zurich Switzerland

Department of Cardiology University Hospital Basel Basel Switzerland

Department of Cardiovascular Diseases Mayo Clinic Rochester MN USA

Department of Cardiovascular Sciences Catholic University of the Sacred Heart Rome Rome Italy

Department of General and Interventional Cardiology University Heart Center Hamburg Hamburg Germany

Department of Internal Medicine 2 Cardiology University of Ulm Medical Center Ulm Germany

Department of Internal Medicine 3 Heart Center University of Cologne Cologne Germany

Department of Internal Medicine B University Medicine Greifswald Greifswald Germany

Department of Internal Medicine Cardiology University of Leipzig Heart Center Leipzig Germany

Department of Medicine College of Medicine University of Florida Gainesville FL USA

Deutsches Herzzentrum München Technische Universität München Munich Germany

Discipline of Medicine Queen Elizabeth Hospital University of Adelaide Adelaide Australia

Division of Biological Sciences University of California San Diego San Diego CA USA

Division of Biostatistics Epidemiology Biostatistics and Prevention Institute University of Zurich Zurich Switzerland

Division of Cardiology 'Antonio Cardarelli' Hospital Naples Italy

Division of Cardiology Department of Internal Medicine 3 Angiology and Intensive Medical Care University Hospital Halle Martin Luther University Halle Halle Germany

Division of Cardiology Department of Medical Sciences AOU Citta della Salute e della Scienza University of Turin Turin Italy

DZHK Partner Site Greifswald Greifswald Germany

DZHK Partner Site Hamburg Kiel Luebeck Hamburg Germany

DZHK Partner Site Heidelberg Mannheim Mannheim Germany

DZHK Partner Site Munich Heart Alliance Munich Germany

FB Mathematics and Computer Science University of Bremen Bremen Germany

Heart and Vascular Centre Bad Bevensen Bad Bevensen Germany

Heart Center Turku University Hospital and University of Turku Turku Finland

Heart Department University Hospital 'San Giovanni di Dio e Ruggi d'Aragona' Salerno Italy

Intensive coronary care Unit Moscow City Hospital 1 named after N Pirogov Moscow Russia

Internal Medicine Cardiology Angiology and Pneumology Magdeburg University Magdeburg Germany

Keck School of Medicine University of Southern California Los Angeles CA USA

Klinik für Innere Medizin 3 Universitätsklinikum des Saarlandes Homburg Saar Germany

Krankenhaus 'Maria Hilf' Medizinische Klinik Stadtlohn Germany

Royal Brompton and Harefield Hospitals Trust and Imperial College London UK

Structural Interventional Cardiology University Hospital Careggi Florence Italy

TJ Health Partners Heart and Vascular Glasgow KY USA

University Hospital for Internal Medicine 3 Medical University Innsbruck Innsbruck Austria

Eur Heart J. 2019 Jul 1;40(26):2152-2154. doi: 10.1093/eurheartj/ehz324. PubMed

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Sato HTH, Uchida T, Dote K, Ishihara M.. Tako-tsubo-like left ventricular dysfunction due to multivessel coronary spasm In: Kodama K, Haze K, Hori M, eds. Clinical Aspect of Myocardial Injury: From Ischemia to Heart Failure. Tokyo: Kagakuhyoronsha Publishing; 1990. p56–64. (In Japanese.)

Di Vece D, Citro R, Cammann VL, Kato K, Gili S, Szawan KA, Micek J, Jurisic S, Ding KJ, Bacchi B, Schwyzer M, Candreva A, Bossone E, D'Ascenzo F, Sarcon A, Franke J, Napp LC, Jaguszewski M, Noutsias M, Münzel T, Knorr M, Heiner S, Katus HA, Burgdorf C, Schunkert H, Thiele H, Bauersachs J, Tschöpe C, Pieske BM, Rajan L, Michels G, Pfister R, Cuneo A, Jacobshagen C, Hasenfuβ G, Karakas M, Koenig W, Rottbauer W, Said SM, Braun-Dullaeus RC, Banning A, Cuculi F, Kobza R, Fischer TA, Vasankari T, Airaksinen KEJ, Opolski G, Dworakowski R, MacCarthy P, Kaiser C, Osswald S, Galiuto L, Crea F, Dichtl W, Empen K, Felix SB, Delmas C, Lairez O, El-Battrawy I, Akin I, Borggrefe M, Gilyarova E, Shilova A, Gilyarov M, Horowitz J, Kozel M, Tousek P, Widimský P, Winchester DE, Ukena C, Di Mario C, Prasad A, Böhm M, Bax JJ, Lüscher TF, Ruschitzka F, Ghadri JR, Templin C.. Outcomes associated with cardiogenic shock intakotsubosyndrome. Circulation 2019;139:413–415. PubMed

Ghadri JR, Wittstein IS, Prasad A, Sharkey S, Dote K, Akashi YJ, Cammann VL, Crea F, Galiuto L, Desmet W, Yoshida T, Manfredini R, Eitel I, Kosuge M, Nef HM, Deshmukh A, Lerman A, Bossone E, Citro R, Ueyama T, Corrado D, Kurisu S, Ruschitzka F, Winchester D, Lyon AR, Omerovic E, Bax JJ, Meimoun P, Tarantini G, Rihal C, Y-Hassan S, Migliore F, Horowitz JD, Shimokawa H, Lüscher TF, Templin C.. International expert consensus document on takotsubo syndrome (part II): diagnostic workup, outcome, and management. Eur Heart J 2018;39:2047–2062. PubMed PMC

Templin C, Ghadri JR, Diekmann J, Napp LC, Bataiosu DR, Jaguszewski M, Cammann VL, Sarcon A, Geyer V, Neumann CA, Seifert B, Hellermann J, Schwyzer M, Eisenhardt K, Jenewein J, Franke J, Katus HA, Burgdorf C, Schunkert H, Moeller C, Thiele H, Bauersachs J, Tschöpe C, Schultheiss HP, Laney CA, Rajan L, Michels G, Pfister R, Ukena C, Böhm M, Erbel R, Cuneo A, Kuck KH, Jacobshagen C, Hasenfuss G, Karakas M, Koenig W, Rottbauer W, Said SM, Braun-Dullaeus RC, Cuculi F, Banning A, Fischer TA, Vasankari T, Airaksinen KE, Fijalkowski M, Rynkiewicz A, Pawlak M, Opolski G, Dworakowski R, MacCarthy P, Kaiser C, Osswald S, Galiuto L, Crea F, Dichtl W, Franz WM, Empen K, Felix SB, Delmas C, Lairez O, Erne P, Bax JJ, Ford I, Ruschitzka F, Prasad A, Lüscher TF.. Clinical features and outcomes of takotsubo (stress) cardiomyopathy. N Engl J Med 2015;373:929–938. PubMed

Singh K, Carson K, Hibbert B, Le May M.. Natural history of cardiac arrest in patients with takotsubo cardiomyopathy. Am J Cardiol 2015;115:1466–1472. PubMed

Syed FF, Asirvatham SJ, Francis J.. Arrhythmia occurrence with takotsubo cardiomyopathy: a literature review. Europace 2011;13:780–788. PubMed

Stiermaier T, Rommel KP, Eitel C, Möller C, Graf T, Desch S, Thiele H, Eitel I.. Management of arrhythmias in patients with takotsubo cardiomyopathy: is the implantation of permanent devices necessary? Heart Rhythm 2016;13:1979–1986. PubMed

El-Battrawy I, Lang S, Ansari U, Tülümen E, Schramm K, Fastner C, Zhou X, Hoffmann U, Borggrefe M, Akin I.. Prevalence of malignant arrhythmia and sudden cardiac death in takotsubo syndrome and its management. Europace 2018;20:843–850. PubMed

Madias JE. Cardiac arrest-triggered takotsubo syndrome vs. takotsubo syndrome complicated by cardiac arrest. Int J Cardiol 2016;225:142–143. PubMed

Madias C, Fitzgibbons TP, Alsheikh-Ali AA, Bouchard JL, Kalsmith B, Garlitski AC, Tighe DA, Estes NA 3rd, Aurigemma GP, Link MS.. Acquired long QT syndrome from stress cardiomyopathy is associated with ventricular arrhythmias and torsades de pointes. Heart Rhythm 2011;8:555–561. PubMed

Migliore F, Zorzi A, Perazzolo Marra M, Iliceto S, Corrado D.. Myocardial edema as a substrate of electrocardiographic abnormalities and life-threatening arrhythmias in reversible ventricular dysfunction of takotsubo cardiomypopathy: imaging evidence, presumed mechanisms, and implications for therapy. Heart Rhythm 2015;12:1867–1877. PubMed

Stiermaier T, Eitel C, Denef S, Desch S, Schuler G, Thiele H, Eitel I.. Prevalence and clinical significance of life-threatening arrhythmias in takotsubo cardiomyopathy. J Am Coll Cardiol 2015;65:2148–2150. PubMed

Ghadri JR, Cammann VL, Templin C.. The International Takotsubo Registry: rationale, design, objectives, and first results. Heart Fail Clin 2016;12:597–603. PubMed

Prasad A, Lerman A, Rihal CS.. Apical ballooning syndrome (tako-tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction. Am Heart J 2008;155:408–417. PubMed

Kleinman ME, Brennan EE, Goldberger ZD, Swor RA, Terry M, Bobrow BJ, Gazmuri RJ, Travers AH, Rea T.. Part 5: adult basic life support and cardiopulmonary resuscitation quality: 2015 American Heart Association Guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2015;132:S414–S435. PubMed

Myerburg RJ, Halperin H, Egan DA, Boineau R, Chugh SS, Gillis AM, Goldhaber JI, Lathrop DA, Liu P, Niemann JT, Ornato JP, Sopko G, Van Eyk JE, Walcott GP, Weisfeldt ML, Wright JD, Zipes DP.. Pulseless electric activity: definition, causes, mechanisms, management, and research priorities for the next decade: report from a National Heart, Lung, and Blood Institute workshop. Circulation 2013;128:2532–2541. PubMed

Piccini JP, Allen LA, Kudenchuk PJ, Page RL, Patel MR, Turakhia MP; American Heart Association Electrocardiography and Arrhythmias Committee of the Council on Clinical Cardiology and Council on Cardiovascular and Stroke Nursing. Wearable cardioverter-defibrillator therapy for the prevention of sudden cardiac death: a science advisory from the American heart association. Circulation 2016;133:1715–1727. PubMed

Priori SG, Blomström-Lundqvist C, Mazzanti A, Blom N, Borggrefe M, Camm J, Elliott PM, Fitzsimons D, Hatala R, Hindricks G, Kirchhof P, Kjeldsen K, Kuck KH, Hernandez-Madrid A, Nikolaou N, Norekvål TM, Spaulding C, Van Veldhuisen DJ.. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: the Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC). Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC). Eur Heart J 2015;36:2793–2867. PubMed

Wang Y, Xia L, Shen X, Han G, Feng D, Xiao H, Zhai Y, Chen X, Miao Y, Zhao C, Wang Y, Guo M, Li T, Zhu HY.. A new insight in sudden cardiac death in young people—a systematic review of cases of takotsubo cardiomyopathy. Medicine 2015;94:e1174.. PubMed PMC

Pant S, Deshmukh A, Mehta K, Badheka AO, Tuliani T, Patel NJ, Dabhadkar K, Prasad A, Paydak H.. Burden of arrhythmias in patients with takotsuo cardiomyopathy (Apical Ballooning Syndrome). Int J Cardiol 2013;170:64–68. PubMed

Ancona F, Bertoldi LF, Ruggieri F, Cerri M, Magnoni M, Beretta L, Cianflone D, Camici PG.. Takotsubo cardiomyopathy and neurogenic stunned myocardium: similar albeit different. Eur Heart J 2016;7:2830–2832. PubMed

Napp LC, Kühn C, Bauersachs J.. ECMO in cardiac arrest and cardiogenic shock. Herz 2017;42:27–44. PubMed PMC

Yap YG, Camm AJ.. Drug induced QT prolongation and torsades de pointes. Heart 2003;89:1363–1372. PubMed PMC

Zorzi A, Perazzolo Marra M, Migliore F, De Lazzari M, Tarantini G, Iliceto S, Corrado D.. Relationship between repolarization abnormalities and myocardial edema in atypical tako-tsubo syndrome. J Electrocardiol 2013;46:348–351. PubMed

Imran TF, Rahman I, Dikdan S, Shah R, Niazi OT, Thirunahari N, Alhaj E, Klapholz M, Gaziano JM, Djousse L.. QT prolongation and clinical outcomes in patients with takotsubo cardiomyopathy. Pacing Clin Electrophysiol 2016;39:607–611. PubMed

Samuelov-Kinori L, Kinori M, Kogan Y, Swartzon M, Shalev H, Guy D, Ferenidou F, Mashav N, Sadeh B, Atzmony L, Kliuk-Ben-Basat O, Steinvil A, Justo D.. Takotsubo cardiomyopathy and QT interval prolongation: who are the patients at risk for torsades de pointes? J Electrocardiol 2009;42:353–357. PubMed

Williams ES, Thomas KL, Broderick S, Shaw LK, Velazquez EJ, Al-Khatib SM, Daubert JP.. Race and gender variation in the QT interval and its association with mortality in patients with coronary artery disease: results from the Duke Databank for Cardiovascular Disease (DDCD). Am Heart J 2012;164:434–441. PubMed

Karatolios K, Holzendorf V, Richter A, Schieffer B, Pankuweit S; Competence Network Heart Failure Germany. Long-term outcome and predictors of outcome in patients with non-ischemic dilated cardiomyopathy. Int J Cardiol 2016;220:608–612. PubMed

Madias JE. Takotsubo syndrome/QTc interval prolongation/myocardial edema/cardiac sympathetic denervation/cardiac arrhythmias: a quintet needing exploration. Int J Cardiol 2016;203:259–261. PubMed

Wortsman J, Frank S, Cryer PE.. Adrenomedullary response to maximal stress in humans. Am J Med 1984;77:779–784. PubMed

Paradis NA, Martin GB, Rosenberg J, Rivers EP, Goetting MG, Appleton TJ, Feingold M, Cryer PE, Wortsman J, Nowak RM.. The effect of standard- and high-dose epinephrine on coronary perfusion pressure during prolonged cardiopulmonary resuscitation. JAMA 1991;265:1139–1144. PubMed

Kern KB, Hilwig RW, Rhee KH, Berg RA.. Myocardial dysfunction after resuscitation from cardiac arrest: an example of global myocardial stunning. J Am Coll Cardiol 1996;28:232–240. PubMed

Cha KC, Kim HI, Kim OH, Cha YS, Kim H, Lee KH, Hwang SO.. Echocardiographic patterns of postresuscitation myocardial dysfunction. Resuscitation 2018;124:90–95. PubMed

Madias JE. Cardiac arrest in patients before and after the inception of takotsubo syndrome. Am J Cardiol 2015;115:1785. PubMed

Liang JJ, Cha YM, Oh JK, Prasad A.. Sudden cardiac death: an increasingly recognized presentation of apical ballooning syndrome (takotsubo cardiomyopathy). Heart Lung 2013;42:270–272. PubMed

Prystowsky EN, Padanilam BJ, Joshi S, Fogel RI.. Ventricular arrhythmias in the absence of structural heart disease. J Am Coll Cardiol 2012;59:1733–1744. PubMed

Wittstein IS, Thiemann DR, Lima JA, Baughman KL, Schulman SP, Gerstenblith G, Wu KC, Rade JJ, Bivalacqua TJ, Champion HC.. Neurohumoral features of myocardial stunning due to sudden emotional stress. N Engl J Med 2005;352:539–548. PubMed

Templin C, Ghadri JR, Napp LC.. Takotsubo (stress) cardiomyopathy. N Engl J Med 2015;373:2689–2691. PubMed