Takotsubo Syndrome Complicated by Dynamic Left Ventricular Outflow Tract Obstruction After Left Bundle Branch Area Pacing

Left bundle branch area pacing (LBBAP) has emerged as a physiologic pacing strategy that better preserves ventricular synchrony compared with traditional right ventricular pacing (RVP).1,2 By engaging the native conduction system, LBBAP is associated with narrower QRS duration and improved hemodynamic performance.3,4 Although generally safe, the transseptal lead approach carries procedure-specific risks,5-7 including septal injury, coronary trauma, and rare stress-related cardiomyopathy. Takotsubo syndrome (TTS) has been reported after pacemaker implantation,8 including LBBAP.