Frailty and cognitive impairment are predictive of takotsubo syndrome following pacemaker implantation

Background Pacemaker (PM) implantation may cause acute emotional distress leading to takotsubo syndrome (TTS). Frailty and cognitive impairment are known to influence outcomes after surgical procedures. It is unclear whether they may also predispose to TTS following PM implantation. Methods We identified nine cases (81 +/- 6 years) of TTS following PM implantation that took place between 2013 and 2017 in one high volume implantation center. TTS was diagnosed based on typical echocardiographic appearance with resolution over time and (in cases where deemed necessary) normal coronary angiography. The TTS cases were compared with 30 consecutive cases of PM implantation (75 +/- 9 years), which were not complicated by TTS (control group). Frailty was assessed using retrospective Risk Analysis Index (RAI-A). Pacing parameters were analyzed during PM implantation and after 1 month. Results Cognitive impairment was more prevalent (67% vs 10%,P = .0005), and RAI-A index was significantly higher in the TTS group compared to the control group (26 +/- 13.7 vs 13.1 +/- 9.8,P = .008). Perioperative right ventricular threshold was significantly higher in patients with TTS comparing to controls (0.99 +/- 0.43 V vs 0.74 +/- 0.20 V,P = .04). The magnitude of decrease in right ventricular threshold between implantation and 1 month follow-up was greater in TTS patients compared to controls (-0.41 +/- 0.29 V vs -0.15 +/- 0.38 V,P = .049). Conclusions TTS is a rare complication of PM implantation. Patients with cognitive impairment and frailty are at risk of TTS. Right ventricular pacing threshold is acutely affected by TTS and improves over time.