We thank Dr Ronan Walsh and his team for showing interest in our paper, as well as allowing us the opportunity to further discuss it.
Several factors have been reported to trigger takotsubo cardiomyopathy (TCM). In the setting of surgical procedures, the very anesthetic act has been described as a trigger for TCM.1,2 A recognizable number of other triggers are thought to be implicated in TCM onset in this scenario.1,2 However, lead extractions as possible triggers for TCM are not yet published.
We recognize that aggressive lead extractions rather than simple lead placement might be a trigger for TCM; however, we hypothesized that this was not the case in our procedure, based on 3 elements. (1) The first approach of the surgical team was not to extract the ventricular lead. The team noticed that it was untied from its venous path and also from the right ventricular apex; hence, if left unextracted, it might still contribute to lead dysfunction and pacemaker malfunctioning. (2) There was no need for mechanical or laser extraction material to remove the electrode. (3) The patient experienced hypertension during the procedure at the time of the new lead placement in the deep septal position, possibly owing to pain at that point of time.
In conclusion, we recognized that TCM might have several triggers involving surgical procedures, including right ventricular lead extraction as one of them in our case. However, in light of the above-mentioned explanation, we strongly realized that the new lead placement was the trigger for TCM in this particular case.
References
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