Why the study?
Persistent bradycardia and high-grade AV block may cause persistently prolonged QTc and life-threatening ventricular arrhythmias, requiring management of the underlying cause.
This case highlights the importance of recognizing and treating bradycardia-induced Torsades de Pointes in patients with high-grade AV block by increasing heart rate and placing a permanent pacemaker.
May support isoproterenol, magnesium, and pacing in bradycardia-induced TdP with AV block; hypothesis-generating and requires prospective validation.
Bradycardia is known to prolong QT interval. Persistent bradycardia and high-grade atrioventricular (AV) block may lead to persistently prolonged QTc interval with a risk for life-threatening ventricular arrhythmias, which needs addressing the underlying cause. We present the case of a patient with persistent sinus bradycardia with a high-grade AV block leading to persistently prolonged QTc without any reversible etiology that resulted in torsades de pointes. The underlying treatment involved shortening the QTc by increasing the heart rate to prevent any further episodes of polymorphic ventricular tachycardia.
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Bhattad et al. (2023) studied this question.
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