Impact of Atrial Fibrillation on Outcome in Takotsubo Syndrome: Data From the International Takotsubo Registry
Authors: El‐Battrawy Ibrahim , Cammann Victoria L. , Kato Ken , Szawan Konrad A. , Di Vece Davide , Rossi Aurelio , Wischnewsky Manfred , Hermes‐Laufer Julia , Gili Sebastiano , Citro Rodolfo , Bossone Eduardo , Neuhaus Michael , Franke Jennifer , Meder Benjamin , Jaguszewski Milosz , Noutsias Michel , Knorr Maike , Heiner Susanne , D’Ascenzo Fabrizio , Dichtl Wolfgang , Burgdorf Christof , Kherad Behrouz , Tschöpe Carsten , Sarcon Annahita , Shinbane Jerold , Rajan Lawrence , Michels Guido , Pfister Roman , Cuneo Alessandro , Jacobshagen Claudius , Karakas Mahir , Koenig Wolfgang , Pott Alexander , Meyer Philippe , David Arroja Jose , Banning Adrian , Cuculi Florim , Kobza Richard , Fischer Thomas A. , Vasankari Tuija , Airaksinen K. E. Juhani , Napp L. Christian , Budnik Monika , Dworakowski Rafal , MacCarthy Philip , Kaiser Christoph , Osswald Stefan , Galiuto Leonarda , Chan Christina , Bridgman Paul , Beug Daniel , Delmas Clément , Lairez Olivier , Gilyarova Ekaterina , Shilova Alexandra , Gilyarov Mikhail , Kozel Martin , Tousek Petr , Winchester David E. , Galuszka Jan , Ukena Christian , Poglajen Gregor , Carrilho‐Ferreira Pedro , Hauck Christian , Paolini Carla , Bilato Claudio , Kobayashi Yoshio , Prasad Abhiram , Rihal Charanjit S. , Liu Kan , Schulze P. Christian , Bianco Matteo , Jörg Lucas , Rickli Hans , Pestana Gonçalo , Nguyen Thanh H. , Böhm Michael , Maier Lars S. , Pinto Fausto J. , Widimský Petr , Felix Stephan B. , Opolski Grzegorz , Braun‐Dullaeus Ruediger C. , Rottbauer Wolfgang , Hasenfuß Gerd , Pieske Burkert M. , Schunkert Heribert , Thiele Holger , Bauersachs Johann , Katus Hugo A. , Horowitz John D. , Di Mario Carlo , Münzel Thomas , Crea Filippo , Bax Jeroen J. , Lüscher Thomas F. , Ruschitzka Frank , Duru Firat , Borggrefe Martin , Ghadri Jelena R. , Akin Ibrahim , Templin Christian 
Published: July 2021

Background
Atrial fibrillation (AF) is a major risk factor for mortality. The prevalence, clinical correlates, and prognostic impact of AF in Takotsubo syndrome (TTS) have not yet been investigated in a large patient cohort. This study aimed to investigate the prevalence, clinical correlates, and prognostic impact of AF in patients with TTS.

Methods and Results

Patients with TTS were enrolled from the International Takotsubo Registry, which is a multinational network with 26 participating centers in Europe and the United States. Patients were dichotomized according to the presence or absence of AF at the time of admission. Of 1584 patients with TTS, 112 (7.1%) had AF. The mean age was higher (
P
<0.001), and there were fewer women (
P
=0.046) in the AF than in the non‐AF group. Left ventricular ejection fraction was significantly lower (
P
=0.001), and cardiogenic shock was more often observed (
P
<0.001) in the AF group. Both in‐hospital (
P
<0.001) and long‐term mortality (
P
<0.001) were higher in the AF group. Multivariable Cox regression analysis revealed that AF was independently associated with higher long‐term mortality (hazard ratio, 2.31; 95% CI, 1.50–3.55;
P
<0.001). Among patients with AF on admission, 42% had no known history of AF before the acute TTS event, and such patients had comparable in‐hospital and long‐term outcomes compared with those with a history of AF.

Conclusions
In patients presenting with TTS, AF on admission is significantly associated with increased in‐hospital and long‐term mortality rates. Whether antiarrhythmics and/or cardioversion are beneficial in TTS with AF should thus be tested in a future trial.

Registration

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT01947621.