Takotsubo Cardiomyopathy after Permanent Pacemaker Implantation: Insights from a Rare Clinical Case

Takotsubo cardiomyopathy is a cardiac syndrome described as a typical form of non-ischemic acute transient left ventricular dysfunction usually associated with a stressful event. We hereby report the case of an 85-year-old frail woman with 2:1 atrio-ventricular nodal block who underwent isoprenaline infusion and permanent pacemaker implantation. After the procedure, she developed an acute left ventricular impairment with typical apical ballooning, not documented on preoperative echocardiography, in the absence of coronary artery stenosis shown on coronary angiography. The patient was treated with conventional heart failure therapy and completely recovered, confirming our clinical hypothesis. Pre-existing factors on one hand and emerging factors on the other could have favored an anomalous, both endogenous and exogenous, catecholamine release, which could have contributed to precipitate this syndrome. Takotsubo cardiomyopathy should be considered as a rare, but potential complication following permanent pacemaker implantation, that has to be kept in mind by clinicians in order to apply the right diagnostic-therapeutic strategy.