Key result
Ondansetron administration in the setting of hypokalemia and hypomagnesemia triggered life-threatening torsades de pointes in a 19-year-old woman with latent long QT syndrome, requiring an ICD.
Case Report (n=1)
No
Latent congenital Long QT Syndrome can be unmasked by QT-prolonging medications like ondansetron and electrolyte abnormalities, leading to life-threatening Torsades de Pointes that may require ICD placement.
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Supports avoiding ondansetron with uncorrected electrolytes; leaves open whether latent LQTS screening should precede antiemetic use.
Long QT syndrome (LQTS) can present with syncope and seizure-like activity in the setting of torsades de pointes (TdP) with hemodynamic instability. Electrolyte abnormalities and medications can predispose to TdP in the setting of latent LQTS. An implantable cardioverter defibrillator (ICD) is needed if patients with TdP continue to be symptomatic despite medical treatment. We report a case of a patient who presented with seizures and was found to have prolonged corrected QT interval (QTc). During her admission, she was treated with ondansetron. She went into torsades de pointes and continued to have prolonged QTc. She underwent implantable cardioverter defibrillator (ICD) placement and remains asymptomatic to date.
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Sethi et al. (2017) conducted a case report in Long QT Syndrome and Torsades de Pointes (n=1). Ondansetron and electrolyte abnormalities was evaluated. Ondansetron administration in the setting of hypokalemia and hypomagnesemia triggered life-threatening torsades de pointes in a 19-year-old woman with latent long QT syndrome, requiring an ICD.
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