Key result
An implantable cardioverter-defibrillator was successfully placed in a 57-year-old female who experienced a catastrophic QT prolongation and cardiac arrest due to an interplay of multiple reversible factors.
Why the study?
ICDs are indicated in LQTS without reversible causes, prompting examination of risks of catastrophic QT prolongation in morbidly obese patients post-bariatric surgery.
Case Report (n=1)
This case highlights the severe risk of catastrophic QT prolongation in patients with multiple predisposing factors, such as bariatric surgery malabsorption and QT-prolonging medications, and illustrates the complex decision-making for ICD placement in acquired LQTS.
Implantable cardioverter-defibrillators (ICDs) are used in patients without a reversible cause for long QT syndrome (LQTS) and secondary prevention in patients with LQTS-associated sudden cardiac arrest. We present a female patient with multiple reversible factors for QT prolongation, including the use of antidepressants, antidiarrheals, antiemetics, and antihistamines; chronic malabsorption from bariatric surgery; probable Gitelman syndrome and urinary losses of electrolytes, causing QT prolongation which leads to polymorphic ventricular tachycardia and a successfully resuscitated cardiac arrest. Our patient also had history suggestive of probable congenital LQTS with multiple childhood syncopal episodes and a history of seizures in first-degree relatives, further justifying the placement of an ICD. Also, this case gives us an opportunity to delve into the risks of catastrophic QT prolongation in the morbidly obese population undergoing bariatric surgery.
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Vyas et al. (2020) conducted a case report in Acquired Long QT Syndrome (n=1). Implantable cardioverter-defibrillator (ICD) was evaluated. An implantable cardioverter-defibrillator was successfully placed in a 57-year-old female who experienced a catastrophic QT prolongation and cardiac arrest due to an interplay of multiple reversible factors.
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