Critical Convex-Type ST Elevation Correlate With Ventricular Tachyarrhythmia in Takotsubo Cardiomyopathy.

Background: Ventricular tachyarrhythmia (VT) occasionally occurred in patients with Takotsubo cardiomyopathy (TC). Two convex-type ST elevations were significantly related to VT in coronary artery disease.

Methods: This study assessed the correlation between VT and critical ECG patterns, as well other independent predictive factors of in-hospital outcome. Fifty-five consecutive patients fulfilled the diagnostic criteria of Takotsubo Italian Network (TIN) were retrospectively enrolled. The patients were classified into two groups according to their critical ECG patterns and VT occurrence. In-hospital outcomes and influencing factors were analyzed.

Results: The incidence of VT was higher in the critical ECG group than in the Noncritical ECG group (43.8% vs. 2.6%, p < 0.001). In-hospital death was more common in the critical ECG group than in the Noncritical ECG group (25.0% vs. 5.1%, p = 0.032). The composite end-point (combined VT and in-hospital death) revealed significant differences between these two groups (50.0% vs 7.7%, p < 0.001). Multi-variate analysis proved critical ECG type as one independent risk factor of VT (odds ratio [OR] = 61.8, p = 0.009) and the composite end-point (OR = 12.4, p = 0.007). The prolong QRS width ( ≥ 105 ms) was another independent factor for predicting VT (OR = 1.06, p = 0.022) and composite end-point (OR = 1.05, p = 0.017).

Conclusions: Critical ECG types including tombstoning ST elevation and lambda-wave ST elevation have strong impact on short-term outcomes. Additionally, conduction disturbance with prolong QRS ≥ 105 ms also has independent predicting role for poor prognosis.