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

## TL;DR

This paper reviews how cardiac pacing can lead to Takotsubo syndrome, focusing on mechanical and clinical factors.

## Contribution

The paper highlights intraventricular mechanical factors as potential triggers for Takotsubo syndrome during cardiac pacing.

## Key findings

- Takotsubo syndrome can occur due to cardiac pacing procedures like pacemaker implantation.
- Intraventricular mechanical factors may play a key role in triggering Takotsubo syndrome.
- The condition may be underdiagnosed due to atypical symptoms and ECG changes.

## Abstract

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.