Cardiac arrest in takotsubo syndrome: results from the InterTAK Registry
Authors: Gili Sebastiano , Cammann Victoria L , Schlossbauer Susanne A , Kato Ken , D’Ascenzo Fabrizio , Di Vece Davide , Jurisic Stjepan , Micek Jozef , Obeid Slayman , Bacchi Beatrice , Szawan Konrad A , Famos Flurina , Sarcon Annahita , Levinson Rena , Ding Katharina J , Seifert Burkhardt , Lenoir Olivia , Bossone Eduardo , Citro Rodolfo , Franke Jennifer , Napp L Christian , Jaguszewski Milosz , Noutsias Michel , Münzel Thomas , Knorr Maike , Heiner Susanne , Katus Hugo A , Burgdorf Christof , Schunkert Heribert , Thiele Holger , Bauersachs Johann , Tschöpe Carsten , Pieske Burkert M , Rajan Lawrence , Michels Guido , Pfister Roman , Cuneo Alessandro , Jacobshagen Claudius , Hasenfuß Gerd , Karakas Mahir , Koenig Wolfgang , Rottbauer Wolfgang , Said Samir M , Braun-Dullaeus Ruediger C , Banning Adrian , Cuculi Florim , Kobza Richard , Fischer Thomas A , Vasankari Tuija , Airaksinen K E Juhani , Opolski Grzegorz , Dworakowski Rafal , MacCarthy Philip , Kaiser Christoph , Osswald Stefan , Galiuto Leonarda , Crea Filippo , Dichtl Wolfgang , Empen Klaus , Felix Stephan B , Delmas Clément , Lairez Olivier , El-Battrawy Ibrahim , Akin Ibrahim , Borggrefe Martin , Gilyarova Ekaterina , Shilova Alexandra , Gilyarov Mikhail , Horowitz John D , Kozel Martin , Tousek Petr , Widimský Petr , Winchester David E , Ukena Christian , Gaita Fiorenzo , Di Mario Carlo , Wischnewsky Manfred B , Bax Jeroen J , Prasad Abhiram , Böhm Michael , Ruschitzka Frank , Lüscher Thomas F , Ghadri Jelena R , Templin Christian 
Published: March 2019

Abstract

Aims
We aimed to evaluate the frequency, clinical features, and prognostic implications of cardiac arrest (CA) in takotsubo syndrome (TTS).

Methods and results
We reviewed the records of patients with CA and known heart rhythm from the International Takotsubo Registry. The main outcomes were 60-day and 5-year mortality. In addition, predictors of mortality and predictors of CA during the acute TTS phase were assessed. Of 2098 patients, 103 patients with CA and known heart rhythm during CA were included. Compared with patients without CA, CA patients were more likely to be younger, male, and have apical TTS, atrial fibrillation (AF), neurologic comorbidities, physical triggers, and longer corrected QT-interval and lower left ventricular ejection fraction on admission. In all, 57.1% of patients with CA at admission had ventricular fibrillation/tachycardia, while 73.7% of patients with CA in the acute phase had asystole/pulseless electrical activity. Patients with CA showed higher 60-day (40.3% vs. 4.0%, P &lt; 0.001) and 5-year mortality (68.9% vs. 16.7%, P &lt; 0.001) than patients without CA. T-wave inversion and intracranial haemorrhage were independently associated with higher 60-day mortality after CA, whereas female gender was associated with lower 60-day mortality. In the acute phase, CA occurred less frequently in females and more frequently in patients with AF, ST-segment elevation, and higher C-reactive protein on admission.

Conclusions
Cardiac arrest is relatively frequent in TTS and is associated with higher short- and long-term mortality. Clinical and electrocardiographic parameters independently predicted mortality after CA.