Polymorphic ventricular arrhythmia triggered by temporary epicardial right ventricular stimulation after cardiac surgery

Key Teaching Points•The proarrhythmic effect of epicardial pacing is rare but needs to be taken into consideration, in the setting of either monomorphic reentrant tachycardia or polymorphic arrhythmias, depending on the clinical situation.•Short-coupled premature ventricular complexes are the manifestation of early afterdepolarization in patients predisposed to QT prolongation and may lead to torsades de pointes.•Amiodarone is the first-line antiarrhythmic drug in structural heart disease, but its proarrhythmic effects are usually underestimated, particularly in women and in the presence of concomitant factors that could prolong the QT interval. •The proarrhythmic effect of epicardial pacing is rare but needs to be taken into consideration, in the setting of either monomorphic reentrant tachycardia or polymorphic arrhythmias, depending on the clinical situation.•Short-coupled premature ventricular complexes are the manifestation of early afterdepolarization in patients predisposed to QT prolongation and may lead to torsades de pointes.•Amiodarone is the first-line antiarrhythmic drug in structural heart disease, but its proarrhythmic effects are usually underestimated, particularly in women and in the presence of concomitant factors that could prolong the QT interval.