Introduction: Cardiac arrest (CA) has been often reported in Takotsubo syndrome (TTS), however scarce data is available on the true prevalence and the natural history of this event.
Hypothesis: To investigate the prevalence, clinical features and impact on mortality of CA occurring in the acute phase of TTS.
Methods: Patients were enrolled from the InterTAK Registry, an international, multicenter registry of patients with TTS. Patients’ records were analysed for the occurrence of CA. Patiens`underlying heart rhythm (ventricular fibrillation [VF] or tachycardia [VT], pulseless electrical activity [PEA] or asystolia) at index event and timing of CA was determined. Main outcomes were 60-days and 5-years mortality.
Results: Out of 2098 patients, CA was reported in 170 patients (8.1%; 121 with medical records available). Patients with CA were younger, more frequently males and with the apical ballooning type, had more often atrial fibrillation, acute neurological comorbidities and physical triggers. On admission, corrected QT interval (cQT) was longer and left ventricular ejection fraction (LVEF) lower. CA was associated with an increased 60-days (34.7% vs. 3.1%, p <0.001) and 5-years mortality rate (44.6% vs. 7.2% p <0.001, also after excluding patients dying in the first 60 days). Male sex, T-wave inversion on admission, longer cQT and intracranial bleeding emerged as independent predictors of 60-days mortality following CA. Eighty four (81.6%) patients (out of 103 with available data) presented CA before and 19 (18.4%) after the TTS diagnosis. VF/VT were more prevalent in patients with CA before TTS diagnosis (57.1%) while PEA/asystolia were more frequently found in the patients with CA after TTS diagnosis (73.7%). Patients with CA after TTS diagnosis were more frequently males, had more often ST-segment elevation on admission, higher BNP values and lower LVEF compared to those without CA.
Conclusions: CA is relatively frequent in the acute phase of TTS and it is associated with a poor outcome, also in patients surviving the acute phase. Clinical and ECG parameters independently predict mortality following CA.