Takotsubo Syndrome After Pulsed-Field Ablation for Atrial Fibrillation

BACKGROUND: Takotsubo syndrome (TS) is a transient, nonischemic cardiomyopathy, often in response to physical or emotional stress. To date, TS has not been reported in association with pulsed-field ablation (PFA) for atrial fibrillation (AF). CASE PRESENTATION: We report a case of asymptomatic and rapidly recovering takotsubo cardiomyopathy in a 72-year-old woman after PFA for paroxysmal AF. Routine postprocedural follow-up revealed T-wave inversions on electrocardiogram, apical akinesis on echocardiography, and elevated high-sensitivity troponin T levels. Urgent coronary angiography showed normal coronaries. Cardiac magnetic resonance findings were consistent with TS, demonstrating myocardial edema without late gadolinium enhancement. DISCUSSION: TS is a quite rare complication of AF ablation. Diagnosis of TS requires a combination of clinical suspicion, biomarkers, and multimodality imaging. TAKE-HOME MESSAGES: PFA can be a potential trigger of TS, even in the absence of intraprocedural complications. TS may occur silently and resolve spontaneously, emphasizing the importance of clinical attention.