{
  "abstract": "Background Atrioventricular block (AVB) in Takotsubo cardiomyopathy (TCM) is a rarely reported complication. Due to its low incidence and lack of randomised trials, there remain significant gaps in the evidence regarding its underlying mechanisms, the probability of conduction recovery and the optimal timing for permanent pacemaker implantation.Methods A systematic review was conducted on published case reports on TCM associated with high-grade AVB, diagnosed simultaneously or within the same hospital admission. Cases with low-grade AVB, sole sinus node disease or TCM induced by pacemaker implantation were excluded.Results A total of 50 cases were included in the final analysis; stratified into two groups based on AVB recovery. Fifteen patients (30%) developed complete AVB recovery. Compared with persistent AVB, those who experienced recovery were younger (median (IQR): 66 (61–73) vs 77 (65–82), p=0.02), more frequently reported identifiable emotional or physical stressors (93% vs 49%, p=0.004) and demonstrated earlier recovery of left ventricular ejection fraction (LVEF) within 1 week (60% vs 24%, p=0.02). No significant differences were observed in terms of comorbidities (hypertension in 27% vs 47%, p=0.22), presenting symptoms (chest pain in 40% vs 14%, syncope or presyncope in 27% vs 46%, p=0.22), ST elevation (27% vs 14%, p=0.28) or regional wall motion abnormalities (apical akinesia in 47% vs 46%, p=0.93). On multivariate analysis, the presence of an identifiable stressor was an independent predictor of AVB recovery (HR 8.27; 95% CI 1.07 to 63.73, p=0.04).Conclusion In patients with TCM and high-grade AVB, the absence of a clear stressor highlights the possibility of baseline conduction disorder, with a higher risk of persistent AVB. Earlier LVEF recovery and younger age may help to predict AVB recovery and guide patient selection for PPM implantation.PROSPERO registration number CRD420251173831.",
  "authors": [
    {
      "affiliations": [
        "Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK",
        "Cardiology, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Cairo Governorate, Egypt"
      ],
      "name": "Hossameldin Hussein"
    },
    {
      "affiliations": [
        "Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK"
      ],
      "name": "Paula Derias"
    },
    {
      "affiliations": [
        "Airedale General Hospital, Keighley, England, UK"
      ],
      "name": "Hadeer Kassem"
    },
    {
      "affiliations": [
        "Cardiology, University Hospitals Dorset NHS Foundation Trust, Poole, England, UK"
      ],
      "name": "Wessam Ali"
    },
    {
      "affiliations": [
        "Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK",
        "Centre for Health and Life Sciences, Coventry University, Coventry, UK"
      ],
      "name": "Patrick Tran"
    },
    {
      "affiliations": [
        "Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK",
        "University of Warwick, Coventry, UK"
      ],
      "name": "Michael Kuehl"
    }
  ],
  "title": "Predictors of high-grade atrioventricular block recovery in Takotsubo cardiomyopathy: a systematic review of case reports",
  "uid": "abc64243-62b7-5485-b3ab-8a1038610d77"
}