Recurrent Takotsubo Syndrome After Pacemaker Implantation

BACKGROUND: Takotsubo syndrome (stress cardiomyopathy) is a reversible ventricular systolic dysfunction presenting as acute heart failure, typically precipitated by emotional or physical stress. It features transient apical ballooning or regional wall-motion abnormalities and often requires distinction from acute coronary syndrome. Although episodes soon after pacemaker implantation are described, recurrence within three months of apparent recovery is rare. CASE SUMMARY: We report a case of a patient who underwent dual-chamber pacemaker implantation for atrioventricular block. One day after discharge, the patient developed acute heart failure and was subsequently diagnosed with previously undiagnosed stress cardiomyopathy. After recovery from the initial episode, the patient experienced a recurrence of stress cardiomyopathy three months later. DISCUSSION: This case illustrates very early, procedure-associated Takotsubo syndrome with short-interval recurrence. Recognition in the peri-implant setting is crucial, as management is supportive and outcomes hinge on timely echocardiography, exclusion of acute coronary syndrome, and structured follow-up. TAKE-HOME MESSAGES: Consider Takotsubo syndrome in peri-implant decompensation after pacemaker implantation; obtain early bedside echocardiography and selective coronary evaluation. Manage with obstruction-aware supportive care; continue RAS blockade after discharge and ensure structured follow-up, as recurrence can occur despite guideline-concordant therapy.