Complete atrioventricular block complicated by QT prolongation triggering repeated torsades de pointes polymorphic ventricular tachycardia

Abstract

This case report describes a 30 years old female who presented to the Emergency with multiple blackouts the previous 3 days. In the Emergency a Torsades de pointes (TdP) polymorphic ventricular tachycardia was observed on the cardiac monitor that spontaneously resolved into complete atrioventricular block accompanied by significantly prolonged QT and corrected QT (QTc)intervals. The patient underwent immediate temporary pacing, followed by permanent dual chamber implantation the next day. There were no further episodes of TdP subsequent to pacemaker implantation; the patient was discharged on a beta-blocker. Complete atrioventricular block when accompanied by increased QTc interval can result in lethal ventricular tachyarrhythmia manifesting as pre syncope, syncope, cardiac arrest, or death. Such patients, albeit uncommon, may be managed by permanent pacing and beta blocker therapy.