Background Atrial fibrillation (AF) is a major risk factor for mortality. The prevalence, clinical correlates, and prognostic impact of AF in Takotsubo syndrome (TTS) have not yet been investigated in a large patient cohort. This study aimed to investigate the prevalence, clinical correlates, and prognostic impact of AF in patients with TTS. Methods and Results Patients with TTS were enrolled from the International Takotsubo Registry, which is a multinational network with 26 participating centers in Europe and the United States. Patients were dichotomized according to the presence or absence of AF at the time of admission. Of 1584 patients with TTS, 112 (7.1%) had AF. The mean age was higher (P<0.001), and there were fewer women (P=0.046) in the AF than in the non-AF group. Left ventricular ejection fraction was significantly lower (P=0.001), and cardiogenic shock was more often observed (P<0.001) in the AF group. Both in-hospital (P<0.001) and long-term mortality (P<0.001) were higher in the AF group. Multivariable Cox regression analysis revealed that AF was independently associated with higher long-term mortality (hazard ratio, 2.31; 95% CI, 1.50-3.55; P<0.001). Among patients with AF on admission, 42% had no known history of AF before the acute TTS event, and such patients had comparable in-hospital and long-term outcomes compared with those with a history of AF. Conclusions In patients presenting with TTS, AF on admission is significantly associated with increased in-hospital and long-term mortality rates. Whether antiarrhythmics and/or cardioversion are beneficial in TTS with AF should thus be tested in a future trial. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01947621.

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

Advanced Heart Failure and Transplantation Center University Medical Center Ljubljana Ljubljana Slovenia

Cardiocenter 3rd Faculty of Medicine Charles University Prague and University Hospital Královské Vinohrady Prague Czech Republic

Cardiology Department Santa Maria University HospitalCHLNCAMLCCULFaculty of MedicineUniversity of Lisbon Lisbon Portugal

Center for Cardiology Cardiology 1 University Medical Center Mainz Mainz Germany

Center for Molecular Cardiology Schlieren Campus University of Zurich Zurich Switzerland

Centro cardiologico MonzinoIRCCS Milan Italy

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 and Internal Medicine B University Medicine Greifswald Greifswald Germany

Department of Cardiology Basil Hetzel InstituteQueen Elizabeth HospitalUniversity of Adelaide Adelaide Australia

Department of Cardiology Centro Hospitalar Universitário de São JoãoE P E Porto Portugal

Department of Cardiology CharitéCampus Rudolf Virchow Berlin Germany

Department of Cardiology Christchurch Hospital Christchurch New Zealand

Department of Cardiology Heidelberg University Hospital Heidelberg Germany

Department of Cardiology Intensive Care Medicine and Angiology Vincentius Diakonissen Hospital Karlsruhe Germany

Department of Cardiology John Radcliffe HospitalOxford University Hospitals Oxford United Kingdom

Department of Cardiology Kantonsspital Frauenfeld Frauenfeld Switzerland

Department of Cardiology Kantonsspital Lucerne Lucerne Switzerland

Department of Cardiology Kantonsspital St Gallen St Gallen Switzerland

Department of Cardiology Kantonsspital Winterthur Winterthur Switzerland

Department of Cardiology King's College Hospital London United Kingdom

Department of Cardiology Leiden University Medical Centre Leiden The Netherlands

Department of Cardiology Medical University of Warsaw Warsaw Poland

Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland

Department of Cardiology University Hospital Basel Basel Switzerland

Department of Cardiovascular Diseases Mayo Clinic Rochester MN

Department of Cardiovascular Medicine Chiba University Graduate School of Medicine Chiba Japan

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

Department of Internal Medicine 1 Cardiology University Hospital Olomouc Olomouc Czech Republic

Department of Internal Medicine 1 University Hospital JenaFriedrich Schiller University Jena Jena Germany

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

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

Department of Internal Medicine Cardiology and Angiology Magdeburg University Magdeburg Germany

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

Deutsches Herzzentrum MünchenTechnische Universität München Munich Germany

Division of Cardiology A O U San Luigi Gonzaga Orbassano Turin Italy

Division of Cardiology Antonio Cardarelli Hospital Naples Italy

Division of Cardiology Department of Medical Sciences AOU Città della Salute e della ScienzaUniversity of Turin Turin Italy

Division of Cardiology Heart and Vascular Center University of Iowa Iowa City IA

Division of Cardiovascular Medicine Department of Medicine College of Medicine University of Florida Gainesville FL

FB Mathematics and Computer Science University of Bremen Bremen Germany

Fondazione Policlinico Universitario A Gemelli IRCCSUniversità Cattolica del Sacro Cuore Rome Italy

German Center for Cardiovascular Researchpartner site Heidelberg Mannheim Mannheim Germany

German Centre for Cardiovascular Research partner site Hamburg Kiel Luebeck Hamburg Germany

German Centre for Cardiovascular Research partner site Munich Heart Alliance Munich Germany

German Centre for Cardiovascular Researchpartner site Greifswald Greifswald 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

Keck School of Medicine University of Southern California Los Angeles CA

Klinik für Innere Medizin IIIUniversitätsklinikum des Saarlandes Homburg Germany

Klinik und Poliklinik für Innere Medizin 2 Universitätsklinikum Regensburg Regensburg Germany

Krankenhaus Maria Hilf Medizinische Klinik Stadtlohn Germany

Local Health Unit N 8 Cardiology Unit Vicenza Italy

Mid German Heart Center Department of Internal Medicine 3 Division of Cardiology Angiology and Intensive Medical Care University Hospital HalleMartin Luther University Halle Wittenberg Halle Germany

Royal Brompton and Harefield Hospitals Trust and Imperial College London United Kingdom

Section of Cardiac Electrophysiology Department of Medicine University of California San Francisco San Francisco CA

Service de Cardiologie Hôpitaux Universitaires de Genève Geneva Switzerland

Structural Interventional Cardiology Careggi University Hospital Florence Italy

TJ Health Partners Heart and Vascular Glasgow KY

University Hospital for Internal Medicine 3 Medical University Innsbruck Innsbruck Austria

Zobrazit více v PubMed

Kato K, Lyon AR, Ghadri JR, Templin C. Takotsubo syndrome: aetiology, presentation and treatment. Heart. 2017;103:1461–1469. DOI: 10.1136/heartjnl-2016-309783. PubMed DOI

Sato H. 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 Co; 1990:56–64 (Article in Japanese).

Templin C, Ghadri JR, Diekmann J, Napp LC, Bataiosu DR, Jaguszewski M, Cammann VL, Sarcon A, Geyer V, Neumann CA, et al. Clinical features and outcomes of takotsubo (stress) cardiomyopathy. N Engl J Med. 2015;373:929–938. DOI: 10.1056/NEJMoa1406761. PubMed DOI

Ghadri JR, Kato K, Cammann VL, Gili S, Jurisic S, Di Vece D, Candreva A, Ding KJ, Micek J, Szawan KA, et al. Long‐term prognosis of patients with takotsubo syndrome. J Am Coll Cardiol. 2018;72:874–882. DOI: 10.1016/j.jacc.2018.06.016. PubMed DOI

Ghadri J‐R, Wittstein IS, Prasad A, Sharkey S, Dote K, Akashi YJ, Cammann VL, Crea F, Galiuto L, Desmet W, et al. International expert consensus document on takotsubo syndrome (part II): diagnostic workup, outcome, and management. Eur Heart J. 2018;39:2047–2062. DOI: 10.1093/eurheartj/ehy077. PubMed DOI PMC

Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, de Ferranti S , Despres JP, Fullerton HJ, Howard VJ, et al. Heart disease and stroke statistics–2015 update: a report from the American Heart Association. Circulation. 2015;131:e29–e322. PubMed

Benjamin EJ, Wolf PA, D'Agostino RB, Silbershatz H, Kannel WB, Levy D. Impact of atrial fibrillation on the risk of death: The Framingham heart study. Circulation. 1998;98:946–952. DOI: 10.1161/01.CIR.98.10.946. PubMed DOI

Stiermaier T, Santoro F, Eitel C, Graf T, Möller C, Tarantino N, Guastafierro F, Di Biase M, Thiele H, Brunetti ND, et al. Prevalence and prognostic relevance of atrial fibrillation in patients with takotsubo syndrome. Int J Cardiol. 2017;245:156–161. DOI: 10.1016/j.ijcard.2017.07.053. PubMed DOI

El‐Battrawy I, Lang S, Ansari U, Behnes M, Hillenbrand D, Schramm K, Fastner C, Zhou X, Bill V, Hoffmann U, et al. Impact of concomitant atrial fibrillation on the prognosis of takotsubo cardiomyopathy. Europace. 2017;19:1288–1292. DOI: 10.1093/europace/euw293. PubMed DOI

Jesel L, Berthon C, Messas N, Lim HS, Girardey M, Marzak H, Marchandot B, Trinh A, Ohlmann P, Morel O. Atrial arrhythmias in takotsubo cardiomyopathy: incidence, predictive factors, and prognosis. Europace. 2019;21:298–305. DOI: 10.1093/europace/euy147. PubMed DOI

Prasitlumkum N, Kittipibul V, Limpruttidham N, Rattanawong P, Chongsathidkiet P, Boondarikpornpant T. The presence of atrial fibrillation in takotsubo cardiomyopathy is predictive of mortality: systematic review and meta‐analysis. Ann Noninvasive Electrocardiol. 2019;24.e12566 DOI: 10.1111/anec.12566. PubMed DOI PMC

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. DOI: 10.1016/j.ahj.2007.11.008. PubMed DOI

Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomstrom‐Lundqvist C, Boriani G, Castella M, Dan GA, Dilaveris PE, et al. 2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio‐Thoracic Surgery (EACTS). Eur Heart J. 2021;42:373–498. PubMed

Peduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR. A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol. 1996;49:1373–1379. DOI: 10.1016/S0895-4356(96)00236-3. PubMed DOI

Song BG, Hahn J‐Y, Cho SJ, Park YH, Choi SM, Park JH, Choi S‐H, Choi J‐H, Park SW, Lee SH, et al. Clinical characteristics, ballooning pattern, and long‐term prognosis of transient left ventricular ballooning syndrome. Heart Lung. 2010;39:188–195. DOI: 10.1016/j.hrtlng.2009.07.006. PubMed DOI

Santoro F, Tarantino N, Ferraretti A, Ieva R, Musaico F, Guastafierro F, Di Martino L, Di Biase M, Brunetti ND. Serum interleukin 6 and 10 levels in takotsubo cardiomyopathy: Increased admission levels may predict adverse events at follow‐up. Atherosclerosis. 2016;254:28–34. DOI: 10.1016/j.atherosclerosis.2016.09.012. PubMed DOI

Jalloul Y, Refaat MM. Il‐6 rapidly induces reversible atrial electrical remodeling by downregulation of cardiac connexins. J Am Heart Assoc. 2019;8:e013638. DOI: 10.1161/JAHA.119.013638. PubMed DOI PMC

Hu YF, Chen YJ, Lin YJ, Chen SA. Inflammation and the pathogenesis of atrial fibrillation. Nat Rev Cardiol. 2015;12:230–243. DOI: 10.1038/nrcardio.2015.2. PubMed DOI

Harada M, Van Wagoner DR, Nattel S. Role of inflammation in atrial fibrillation pathophysiology and management. Circ J. 2015;79:495–502. DOI: 10.1253/circj.CJ-15-0138. PubMed DOI PMC

Jabre P, Roger VL, Murad MH, Chamberlain AM, Prokop L, Adnet F, Jouven X. Mortality associated with atrial fibrillation in patients with myocardial infarction: a systematic review and meta‐analysis. Circulation. 2011;123:1587–1593. DOI: 10.1161/CIRCULATIONAHA.110.986661. PubMed DOI PMC

Mitsuma W, Kodama M, Ito M, Kimura S, Tanaka K, Hoyano M, Hirono S, Aizawa Y. Thromboembolism in takotsubo cardiomyopathy. Int J Cardiol. 2010;139:98–100. DOI: 10.1016/j.ijcard.2008.06.089. PubMed DOI

Wu MH, Lu CW, Chen HC, Chiu SN, Kao FY, Huang SK. Arrhythmic burdens in patients with tetralogy of fallot: a national database study. Heart Rhythm. 2015;12:604–609. DOI: 10.1016/j.hrthm.2014.11.026. PubMed DOI

Aleksova A, Merlo M, Zecchin M, Sabbadini G, Barbati G, Vitrella G, Di Lenarda A, Sinagra G. Impact of atrial fibrillation on outcome of patients with idiopathic dilated cardiomyopathy: data from the heart muscle disease registry of trieste. Clin Med Res. 2010;8:142–149. DOI: 10.3121/cmr.2010.908. PubMed DOI PMC

Link MS, Giugliano RP, Ruff CT, Scirica BM, Huikuri H, Oto A, Crompton AE, Murphy SA, Lanz H, Mercuri MF, et al. Stroke and mortality risk in patients with various patterns of atrial fibrillation: results from the engage AF‐TIMI 48 trial (effective anticoagulation with factor XA next generation in atrial fibrillation‐thrombolysis in myocardial infarction 48). Circ Arrhythm Electrophysiol. 2017;10. DOI: 10.1161/CIRCEP.116.004267. PubMed DOI

Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, Castella M, Diener H‐C, Heidbuchel H, Hendriks J, et al. 2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016;37:2893–2962. DOI: 10.1093/eurheartj/ehw210. PubMed DOI

Rubenstein JC, Cinquegrani MP, Wright J. Atrial fibrillation in acute coronary syndrome. J Atr Fibrillation. 2012;5:551. PubMed PMC

Ravelli F. Mechano‐electric feedback and atrial fibrillation. Prog Biophys Mol Biol. 2003;82:137–149. DOI: 10.1016/S0079-6107(03)00011-7. PubMed DOI

Kamkin A, Kiseleva I, Wagner KD, Leiterer KP, Theres H, Scholz H, Gunther J, Lab MJ. Mechano‐electric feedback in right atrium after left ventricular infarction in rats. J Mol Cell Cardiol. 2000;32:465–477. DOI: 10.1006/jmcc.1999.1091. PubMed DOI

El‐Battrawy I, Zhao Z, Lan H, Schünemann J‐D, Sattler K, Buljubasic F, Patocskai B, Li X, Yücel G, Lang S, et al. Estradiol protection against toxic effects of catecholamine on electrical properties in human‐induced pluripotent stem cell derived cardiomyocytes. Int J Cardiol. 2018;254:195–202. DOI: 10.1016/j.ijcard.2017.11.007. PubMed DOI

Zhang Y, Wang H‐M, Wang Y‐Z, Zhang Y‐Y, Jin X‐X, Zhao Y, Wang J, Sun Y‐L, Xue G‐L, Li P‐H, et al. Increment of late sodium currents in the left atrial myocytes and its potential contribution to increased susceptibility of atrial fibrillation in castrated male mice. Heart Rhythm. 2017;14:1073–1080. DOI: 10.1016/j.hrthm.2017.01.046. PubMed DOI

Triggers, characteristics, and hospital outcome of patients with Takotsubo syndrome: 10 years experience in a large university hospital centre

Zobrazit více v PubMed

ClinicalTrials.gov
NCT01947621