Save
Download PDF

To the Editor:

I read with pleasure the report by Siegfried and colleagues1 about a woman with atrial fibrillation who had an episode of takotsubo cardiomyopathy (TC) immediately after undergoing direct-current electrical cardioversion of her atrial fibrillation. In their discussion, the authors provide a convincing and comprehensive analysis of the incident.

I was impressed with the low voltage in the admission electrocardiogram (ECG) and in the one after cardioversion. Transient low-voltage ECG has been described recently in association with TC2; accordingly, I would greatly appreciate information on the patient's ECGs before hospital admission and at follow-up. If these ECGs did not reveal low voltage, then TC was present before the hospital admission as a result of atrial fibrillation, even though the authors did not observe the consequences of TC in the echocardiogram and the release of cardiac troponin I before cardioversion.

References

  • 1.

    Siegfried JS
    ,
    BhusriS
    ,
    GuttenplanN
    ,
    CoplanNL.
    Takotsubo cardiomyopathy as a sequela of elective direct-current cardioversion for atrial fibrillation. Tex Heart Inst J2014;41 (
    2
    ):184–7.

  • 2.

    Madias JE.
    Transient attenuation of the amplitude of the QRS complexes in the diagnosis of takotsubo syndrome. Eur Heart J Acute Cardiovasc Care2014;3(
    1
    ):28–36.

Jonathan S. Siegfried,
MD
Department of Cardiovascular Medicine, Lenox Hill Hospital, New York, New York

With response by

doi: http://dx.doi.org/10.14503/THIJ-14-4486

This letter was referred to Dr. Jonathan Siegfried, who replies in this manner:

I thank Dr. Madias for his insightful response to our report.1 In regard to the patient's electrocardiographic (ECG) voltage, review of the available data reveals low voltage in the limb and precordial leads 2 years before her presentation (Fig. 1), which was the most recent prior ECG. An ECG obtained at the time of follow-up, 2 weeks after the patient's discharge from the hospital, showed similar findings (Fig. 2). Although there appears to be a general association between low voltage and takotsubo cardiomyopathy,2 in this case the low voltage appears to have been the patient's baseline status, most likely due to body habitus.

Fig. 1. Electrocardiogram shows low voltage in the limb and precordial leads 2 years before the patient's presentation.Fig. 1. Electrocardiogram shows low voltage in the limb and precordial leads 2 years before the patient's presentation.Fig. 1. Electrocardiogram shows low voltage in the limb and precordial leads 2 years before the patient's presentation.
Fig. 1. Electrocardiogram shows low voltage in the limb and precordial leads 2 years before the patient's presentation.

Citation: Texas Heart Institute Journal 41, 4; 10.14503/THIJ-14-4419

Fig. 2. Electrocardiographic findings 2 weeks after the patient's discharge from the hospital are similar to those shown in Figure 1.Fig. 2. Electrocardiographic findings 2 weeks after the patient's discharge from the hospital are similar to those shown in Figure 1.Fig. 2. Electrocardiographic findings 2 weeks after the patient's discharge from the hospital are similar to those shown in Figure 1.
Fig. 2. Electrocardiographic findings 2 weeks after the patient's discharge from the hospital are similar to those shown in Figure 1.

Citation: Texas Heart Institute Journal 41, 4; 10.14503/THIJ-14-4419

References

  • 1.

    Siegfried JS
    ,
    BhusriS
    ,
    GuttenplanN
    ,
    CoplanNL.
    Takotsubo cardiomyopathy as a sequela of elective direct-current cardioversion for atrial fibrillation. Tex Heart Inst J2014;41 (
    2
    ):184–7.

  • 2.

    Madias JE.
    Transient attenuation of the amplitude of the QRS complexes in the diagnosis of takotsubo syndrome. Eur Heart J Acute Cardiovasc Care2014;3(
    1
    ):28–36.

Letters to the Editor should be no longer than 2 double-spaced typewritten pages and should generally contain no more than 6 references. They should be signed, with the expectation that the letters will be published if appropriate. The right to edit all correspondence in accordance with Journal style is reserved by the editors.

  • Download PDF
Copyright: © 2014 by the Texas Heart® Institute, Houston
Fig. 1.
Fig. 1.

Electrocardiogram shows low voltage in the limb and precordial leads 2 years before the patient's presentation.

Fig. 2.
Fig. 2.

Electrocardiographic findings 2 weeks after the patient's discharge from the hospital are similar to those shown in Figure 1.