ArticleEuropean heart journal. Case reports2026
Fluorodeoxyglucose positron emission tomography/computed tomography in Takotsubo cardiomyopathy complicated by sinus arrest and third-degree atrioventricular block: a case report.
Article in European heart journal. Case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Takotsubo cardiomyopathy (TTC) complicated by sinus arrest and third-degree atrioventricular block (AVB) is extremely rare. This case illustrates the utility of 18F-FDG PET/CT (fluorodeoxyglucose positron emission tomography/computed tomography) in characterizing myocardial stunning of TTC with dual nodal dysfunction and provides insights into long-term conduction outcomes. Case summary: A 77-year-old female presented with acute chest pain and palpitations due to emotional stress. Echocardiography showed left ventricular (LV) apical hypokinesis [global longitudinal strain (GLS) -14.8%], coronary computed tomography angiography revealed mild mid-left anterior descending artery stenosis, and cardiac biomarkers were elevated (troponin-T: 0.0803 ng/mL; N-terminal pro-B-type natriuretic peptide: 696.92 ng/L). Holter monitoring documented sinus arrest, third-degree AVB, and a minimum heart rate of 31 b.p.m. Fluorodeoxyglucose positron emission tomography/computed tomography showed increased glucose uptake in the LV apex (consistent with myocardial stunning/inflammation), while technetium-99m methoxyisobutylisonitrile SPECT/CT detected mild apical hypoperfusion. A dual-chamber pacemaker was implanted for refractory bradycardia. At 1-month follow-up, LV apical hypokinesis resolved (GLS -19.0%), with recovered AV nodal but persistent sinoatrial nodal dysfunction. Discussion: Fluorodeoxyglucose positron emission tomography/computed tomography is valuable for clarifying the metabolic basis of TTC-related myocardial dysfunction, complementing perfusion imaging. Early pacing evaluation is critical for TTC patients with sinoatrial nodal impairment-even with AV nodal recovery, persistent sinoatrial dysfunction may require long-term pacing support to prevent bradycardia-related adverse events.
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