A 76-year-old woman with diabetes mellitus developed sudden chest pain and palpitations following cataract surgery, associated with ST-segment elevation, elevated hs-troponin, inflammatory markers, and diabetic ketoacidosis. Coronary angiography showed no significant coronary obstruction, while echocardiography and cardiac MRI confirmed Tako-Tsubo syndrome with apical akinesia and moderately reduced left ventricular ejection fraction. Persistent atrial fibrillation with rapid ventricular response was observed and spontaneously resolved within one month, concomitant with recovery of left ventricular function. This temporal relationship suggests that TTS-related myocardial dysfunction, sympathetic activation, and autonomic imbalance may contribute to the genesis and maintenance of atrial fibrillation. In this setting, diabetic ketoacidosis may have acted as a major physical stressor, triggering TTS and subsequently promoting atrial arrhythmogenesis. This case highlights the potential interplay between diabetic ketoacidosis, TTS, and atrial fibrillation and suggests that TTS may play an important role in the transient development of AF.

Adam Bouzhir completed his specialization in cardiovascular medicine at the age of 30 at the Faculty of Medicine and Pharmacy of Rabat, Morocco. He is currently an associate practitioner at the Nevers Agglomeration Hospital Center, France. He also holds a Diploma in Interventional Cardiology from Université Paris Cité, France, as well as a Diploma in Echocardiography and Non-Invasive Cardiac Imaging from the University of Bordeaux, France. He is currently looking forward to further developing his academic and scientific research activities in cardiovascular medicine.