434 TAKOTSUBO SYNDROME AFTER PACEMAKER IMPLANTATION

Abstract Introduction Takotsubo syndrome is a clinical characterized by typical anamnestic features together with ECG and echocardiographic findings. Comparing the available literature not so many cases of takotsubo after pacemaker implantation can be found. Furthermore, there are only few articles talking about in these patient. The case we described allows to observe dynamic alterations patient electro-induced ventriculograms Case Description A 90-year-old male was admitted emergency room for important fatigue associated severe bradycardia (25/min). His cardiovascular history silent, his past medical high blood pressure, chronic pulmonary obstructive disease anemia due iron deficiency. showed second degree AVB type 2, phases 2:1 paroxysmal third on continuous monitoring. routine tests normal T troponin BNP 420 pg/mL. echocardiogram revealed biventricular dimensions systolic function moderate aortic valve stenosis. underwent urgent permanent DDD without previous isoproterenol administration. During procedure he referred pain site wound, became confused agitated. complicated massive pneumothorax that needed quick decompression. On 2nd day atrium-guided began modify mild ST-segment elevation V2 initial T-wave inversion from V3 V6 I - II aVF. next days, T-waves deeper QTc prolonged 540 ms. These abnormalities were then gradually resolved 11th day. Mild transient attenuation amplitude QRS complexes – leads 1 could reported. Another performed, which new apical akinesis “apical ballooning” aspect EF 40%. TnT values increased. Coronary angiogram performed rejection, coronaropathy excluded certainty. Nevertheless, had pressure as risk factor probability diagnosis cardiomyopathy assessed 76,9% InterTAK diagnostic score, considered most likely diagnosis. Therefore, patient's therapy optimized an increase dosage ACE inhibitors. At one month follow-up remained stable, preserved ejection fraction (EF = 55%), segmental contractility. normal. Therapy left unmodified. Conclusions should consider rare but possible complication implantation. This true especially patients affected frailty cognitive impairment. There no specific criteria ventriculograms, anomalies repolarization similar those spontaneous ventricular activity. Transient voltages seen even just precordial it generally present very acute phase.