Differentiation between Takotsubo syndrome and coronary spastic angina in subjects undergoing catheter ablation for atrial fibrillation

I read with great interest the paper by Sinha et al. about Takotsubo syndrome (TS) in subjects undergoing catheter ablation for atrial fibrillation (AF) based on multicenter retrospective database.1 The author analyzed 69,116 and stated that 27 (0.04%) had a TS diagnostic code. cohort study was compromised mostly of female [17 (63%)], one (3.7%) death within 30 days reported. AF did not occur as often expected authors suggested, but consider an important complication. have two comments questions author: (1) Have you taken into consideration coronary spastic angina (CSA)? It is well known CSA can be caused direct thermal damage resulting from radiofrequency (RF) energy or autonomic nervous system imbalance.2 Furthermore, perioperative sedation dexmedetomidine induce CSA.3 authors' analysis lacked summary vasodilators like nitrates methods sedation. CSA, particularly “wrap around” artery, frequently reported to mimic TS.4 MRI regarded valuable tool distinguishing between conditions. suspect diagnosed might include cases should actually CSA. If feasible, it would reasonable incorporate information vasodilators, such nitrates, analysis. (2) Do substantial finding? In sizable involving non-cardiac surgery, encompassing 1460 liver transplant recipients, 17 patients (1.16%) developed postoperative cardiomyopathy.5 These exhibit myocardial ischemia experienced reversible cardiomyopathy, strongly indicating TS. posit emotional stress associated hospitalization physical during period precipitate Consequently, believe there no correlation Authors declare conflict interests this article.