Synergistic interaction of pathophysiological and pharmacological factors in the development of torsade de pointes

Introduction: Torsade de pointes is a polymorphic ventricular arrhythmia associated with delayed ventricular repolarisation. It typically manifests as transient episodes of dizziness and syncope. In rare cases, this condition may progress to ventricular fibrillation and sudden cardiac death. The most common etiological factors include electrolyte disturbances (hypomagnesemia and hypokalemia), the use of antiarrhythmic drugs (class Ia and class III agents) and antibiotics, bradycardia, and various malignancies. Case report: A 74-year-old male patient was hospitalised at the Urology Clinic of the University Clinical Centre Kragujevac for surgical treatment of urinary bladder carcinoma. During cardiological monitoring, ventricular tachycardia consistent with torsade de points was recorded. Further diagnostic evaluation did not reveal structural cardiac abnormalities that could account for the arrhythmia. Following assessment of the patient's comorbidities and current pharmacotherapy, several potential contributing factors were identified. Adjustment of the therapeutic regimen and correction of the electrolyte imbalance resulted in stabilisation of the patient's clinical condition. Conclusion: The complexity of pharmacotherapy in elderly patients requires careful, rational use of antiarrhythmic drugs, especially given their potential proarrhythmic effects, with particular emphasis on regular monitoring and timely correction of electrolyte disturbances.