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Tex Heart Inst J. 2014 Apr 1;41(2):184-7. doi: 10.14503/THIJ-12-3063. eCollection 2014 Apr.

Takotsubo cardiomyopathy as a sequela of elective direct-current cardioversion for atrial fibrillation.

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Department of Cardiovascular Medicine, Lenox Hill Hospital, New York, NY 10021.


In takotsubo cardiomyopathy, the clinical appearance is that of an acute myocardial infarction in the absence of obstructive coronary artery disease, with apical ballooning of the left ventricle. The condition is usually precipitated by a stressful physical or psychological experience. The mechanism is unknown but is thought to be related to catecholamine excess. We present the case of a 67-year-old woman who experienced cardiogenic shock caused by takotsubo cardiomyopathy, immediately after undergoing elective direct-current cardio-version for atrial fibrillation. After a course complicated by left ventricular failure, cardiogenic shock, and ventricular tachycardia, she made a complete clinical and echocardiographic recovery. In addition to this case, we discuss the possible direct effect of cardioversion in takotsubo cardiomyopathy.


Cardiomyopathies/etiology; electric countershock/adverse effects; recovery of function/physiology; shock, cardiogenic/therapy; takotsubo cardiomyopathy/complications/diagnosis/etiology/physiopathology; treatment outcome; ventricular function, left/physiology

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