Takotsubo syndrome in the setting of cardiac pacing: A review of mechanistic and clinical perspectives

Takotsubo syndrome (TTS) is a reversible form of acute cardiac syndrome usually arising in response to various emotional and physical stressors. TTS due to cardiac pacing has been an uncommon phenomenon mostly attributable to a variety of periprocedural conventional stressors including anxiety, pain and low cardiac output. Interestingly, intraventricular mechanical factors might also play a pivotal role in TTS evolution due to cardiac pacing. Notably, this phenomenon may be potentially underdiagnosed due to a variety of factors including atypical symptoms and masked electrocardiographic (ECG) changes potentially suggesting its higher incidence in clinical practice.The present paper aims to focus on mechanistic and clinical implications of TTS due to cardiac pacing procedures including conventional permanent pacemaker implantation (PPI) and conduction system pacing (CSP) along with a particular emphasis on intraventricular mechanical factors as potential TTS triggers in this context.