Total clinical course of left insular stroke-induced bradycardia-tachycardia and takotsubo syndrome: A case report of stroke-heart syndrome.

We report the total course of left insular stroke-induced bradycardia-tachycardia and takotsubo syndrome in a 71-year-old woman. The patient presented with aphasia and right hemiparesis, and was diagnosed with acute stroke involving the left insular cortex. Eight hours after admission, she exhibited bradycardia-tachycardia syndrome with atrial fibrillation. On day 2 of hospitalization, T-wave inversions of the electrocardiogram were first observed, and echocardiography revealed reduced contraction exclusively at the left ventricular apex, which disappeared on day 35. The T-wave inversion deepened twice afterward. On days 10 and 12 of hospitalization, she experienced asystole episodes of 10.9 and 10.6 s, respectively, without losing consciousness. After day 22, her heart rate never dropped below 40 beats/min during admission. The patient's heart rate remained above 50 beats/min for 21 months after hospital discharge. Learning objective: A left insular stroke can induce bradycardia-tachycardia syndrome, and the time to resolution of the conduction disturbance was 22 days after the initial stroke event. Given the delayed recovery of the cardiac conduction system in stroke-induced bradycardia, there may be unnecessary device implantations. In hemodynamically stable patients with bradycardia due to insular stroke, it may be advisable to wait longer before implanting a permanent pacemaker.