Two cases of torsades de pointes associated with takotsubo cardiomyopathy as the second insult

Torsades de pointes (TdP) is a fatal polymorphic ventricular tachyarrhythmia that is related to QTc prolongation. Takotsubo cardiomyopathy (TCM) is characterized by acute transient left ventricular dysfunction without obstructive coronary artery disease. The QTc interval is always prolonged in TCM; however, TdP is rarely reported in patients with TCM. Despite that the electrocardiograms of patients with TCM unexceptionally demonstrate marked QTc interval prolongation, TdP is rarely associated with TCM, leading to the proposal that TCM is another cause of acquired long QT syndrome and another insult to the repolarization reserve. We identified 2 cases that reinforce this concept.