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

• Published in: Journal of cardiology cases Vol. 25; no. 5; pp. 275 - 278
• Main Authors: Nakagawa, Yoichiro, Furusho, Hiroshi, Kamiya, Yusuke, Nishikawa, Ryo, Miwa, Kenji, Yasuda, Toshihiko
• Format: Journal Article
• Language: English
• Published: Japan Elsevier Ltd 01.05.2022; Japanese College of Cardiology
• Subjects: Atrial flutter; Case Report; Catheter ablation; QT prolongation; Takotsubo cardiomyopathy; Torsades de pointes; Takotsubo cardiomyopathy; QT prolongation; Catheter ablation; Torsades de pointes; Atrial flutter
• ISSN: 1878-5409; 1878-5409
• DOI: 10.1016/j.jccase.2021.11.001

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. <Learning objective: We encountered a case who developed torsades de pointes due to takotsubo cardiomyopathy after catheter ablation for atrial flutter. Currently, the efficacy and safety of catheter ablation have been established. This procedure has become widespread worldwide and is expected to progress in the future. Through this case, we want to focus on a rare complication of catheter ablation. Although the phenomenon we experienced is rarely reported, it should be considered a possible complication.>