QT Prolongation and In-Hospital Ventricular Arrhythmic Complications in Patients With Apical Ballooning Takotsubo Syndrome

Marco Giuseppe Del Buono; Juan Ignacio Damonte; Francesco Moroni; Krishna Ravindra; Peter Westman; Juan G Chiabrando; Edoardo Bressi; Pengyang Li; Kunal Kapoor; Yuxuan Mao; Travis Oakes; Paula Rodriguez-Miguelez; Tamas S Gal; Jayanthi Koneru; Kenneth A Ellenbogen; Jordana Kron; Antonio Abbate

doi:10.1016/j.jacep.2022.08.010

QT Prolongation and In-Hospital Ventricular Arrhythmic Complications in Patients With Apical Ballooning Takotsubo Syndrome

JACC Clin Electrophysiol. 2022 Dec;8(12):1500-1510. doi: 10.1016/j.jacep.2022.08.010. Epub 2022 Sep 28.

Authors

Marco Giuseppe Del Buono¹, Juan Ignacio Damonte², Francesco Moroni³, Krishna Ravindra⁴, Peter Westman⁴, Juan G Chiabrando², Edoardo Bressi⁴, Pengyang Li⁴, Kunal Kapoor⁴, Yuxuan Mao⁴, Travis Oakes⁵, Paula Rodriguez-Miguelez⁶, Tamas S Gal⁷, Jayanthi Koneru⁴, Kenneth A Ellenbogen⁴, Jordana Kron⁴, Antonio Abbate⁸

Affiliations

¹ VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA; Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy.
² VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA; Department of Interventional Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
³ Robert M. Berne Cardiovascular Research Center, and Department of Medicine, Division of Cardiovascular Medicine, Heart and Vascular Center, University of Virginia, Charlottesville, Virginia, USA.
⁴ VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA.
⁵ Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia, USA.
⁶ Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia, USA.
⁷ Department of Biostatistics, Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia, USA.
⁸ VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA; Robert M. Berne Cardiovascular Research Center, and Department of Medicine, Division of Cardiovascular Medicine, Heart and Vascular Center, University of Virginia, Charlottesville, Virginia, USA. Electronic address: antonio.abbate@virginia.edu.

PMID: 36543499
DOI: 10.1016/j.jacep.2022.08.010

Abstract

Background: Takotsubo syndrome is associated with life threatening arrhythmias, and the apical ballooning pattern is characterized by a peculiar QT prolongation and particularly high-risk of arrhythmias.

Objectives: The aim of the study was to determine the association of QT interval on electrocardiogram for ventricular arrhythmic complications in patients with apical ballooning Takotsubo syndrome in a diverse population at a large urban hospital in the U.S.

Methods: We reviewed 105 cases of apical ballooning Takotsubo syndrome in patients admitted between 2011 and 2017. Two cardiologists reviewed the electrocardiograms to measure QT interval, adjusted for rate using the Fridericia formula (QT_CF), and ventricular arrhythmic complications during the hospitalization. Data are reported as median and interquartile range or number and percentage.

Results: Of the 105 patients, 86 (82%) were female, and 34 (32%) were self-reported Black or African American. The mean age was 65 years (range: 58-72 years). Left ventricular ejection fraction was 25% (range: 25%-35%). Heart rate was 101 beats/min (range: 83-121 beats/min). Ten (11%) patients experienced a ventricular arrhythmic complication and had significantly longer QT_CF (470 [range: 422-543] milliseconds) than did those without complications (417 [range: 383-456] milliseconds, P = 0.031). The area under the curve for QT_CF was 0.708 (95% CI: 0.536-0.880; P = 0.031). Twenty-eight (27%) patients had a QT_CF ≥460 milliseconds and significantly more arrhythmic complications (21% vs 5%, odds ratio 4.997 [95% CI: 1.288-19.237], P = 0.021). QT_CF was an independent predictor of ventricular arrhythmias: odds ratio 1.090 for each 10-millisecond increase in QT_CF (95% CI: 1.004-1.183; P = 0.040, corrected for sex).

Conclusions: In a diverse population of patients with apical ballooning Takotsubo syndrome admitted to a large urban hospital in the United States, QT_CF at admission ≥460 milliseconds identifies patients at high risk for in-hospital arrhythmic complications. Further studies are needed to determine strategies aimed at shortening QT interval to potentially prevent life-threatening arrhythmic events.

Keywords: Fridericia formula; QT interval; Takotsubo syndrome; arrhythmias; complications.

Publication types

Review

MeSH terms

Aged
Arrhythmias, Cardiac / complications
Arrhythmias, Cardiac / epidemiology
Female
Hospitals
Humans
Long QT Syndrome* / complications
Long QT Syndrome* / epidemiology
Male
Stroke Volume
Takotsubo Cardiomyopathy* / complications
Ventricular Function, Left