Sinha Neha, Tian Zizhong, Zhou Shouhao, Thomas Neal J, Krawiec Conrad
Pediatric Critical Care Medicine, Department of Pediatrics Penn State Hershey Children's Hospital Hershey Pennsylvania USA.
Division of Biostatistics and Bioinformatics, Department of Public Health Sciences Pennsylvania State University College of Medicine Hershey Pennsylvania USA.
J Arrhythm. 2023 Apr 18;39(3):359-365. doi: 10.1002/joa3.12856. eCollection 2023 Jun.
Intracardiac catheter ablation for atrial fibrillation with pulmonary vein isolation may result in Takotsubo syndrome (TS), but the frequency, predisposing factors (age, sex, mental health disorders), and outcomes are currently unknown. This study sought to assess the frequency, predisposing factors, and outcomes of subjects who underwent intracardiac catheter ablation for atrial fibrillation with pulmonary vein isolation and were diagnosed with TS.
This was a retrospective observational cohort study utilizing TriNetX® electronic health record (EHR) data. We included subjects aged older than 18 years who underwent intracardiac catheter ablation for atrial fibrillation with pulmonary vein isolation. The study population was divided into two groups (no TS diagnostic code presence and TS diagnostic code presence). We analyzed the distributions of age, sex, race, diagnostic codes, common terminology procedures (CPT), and vasoactive medication codes and examined mortality rate within 30 days.
We included 69,116 subjects. Of these, 27 (0.04%) had a TS diagnostic code, the cohort was comprised mostly of females [17 (63.0%)], and 1 (3.7%) death within 30 days was reported. There were no significant differences in age and frequency of mental health disorders between those patients in TS and non-TS cohorts. Adjusting for age, sex, race, ethnicity, patient regionality, and mental health disorder diagnostic code, those patients who developed TS had a significantly higher odds of dying in 30 days after catheter ablation compared to those without TS (OR = 15.97, 95% CI: 2.10-121.55, = .007).
Approximately 0.04% of subjects who underwent intracardiac catheter ablation of atrial fibrillation by pulmonary vein isolation had a subsequent diagnostic code of TS. Further study is needed to determine whether there are predisposing factors associated with the development of TS in subjects who undergo catheter ablation of atrial fibrillation by pulmonary vein isolation.
采用肺静脉隔离术进行心内导管消融治疗心房颤动可能会导致应激性心肌病（TS），但其发生率、易感因素（年龄、性别、精神疾病）及预后目前尚不清楚。本研究旨在评估接受肺静脉隔离术心内导管消融治疗心房颤动并被诊断为TS的患者的发生率、易感因素及预后。
这是一项利用TriNetX®电子健康记录（EHR）数据的回顾性观察队列研究。我们纳入了年龄大于18岁且接受肺静脉隔离术心内导管消融治疗心房颤动的患者。研究人群分为两组（无TS诊断代码组和有TS诊断代码组）。我们分析了年龄、性别、种族、诊断代码、通用术语程序（CPT）和血管活性药物代码的分布情况，并检查了30天内的死亡率。
我们纳入了69116名患者。其中，27名（0.04%）有TS诊断代码，该队列主要由女性组成[17名（63.0%）]，报告了1例（3.7%）在30天内死亡。TS组和非TS组患者在年龄和精神疾病发生率方面无显著差异。在对年龄、性别、种族、民族、患者地区和精神疾病诊断代码进行校正后，与未发生TS的患者相比，发生TS的患者在导管消融后30天内死亡的几率显著更高（OR = 15.97，95% CI：2.10 - 121.55，P = 0.007）。
接受肺静脉隔离术心内导管消融治疗心房颤动的患者中，约0.04%随后有TS诊断代码。需要进一步研究以确定在接受肺静脉隔离术导管消融治疗心房颤动的患者中，是否存在与TS发生相关的易感因素。
