Three rhythms in one presentation: atrial flutter, Torsades de Pointes, and complete heart block

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Atrial flutter, Torsades de Pointes, and complete heart block (n=1). Intervention: Synchronized cardioversion.

Q: What does this research mean for the field?

Severe bradycardia and prolonged post-ectopic pauses (short-long-short sequence) resulting from conduction disease can trigger pause-dependent Torsades de Pointes in the absence of QT-prolonging drugs or electrolyte disturbances. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

Nina George

doi:10.1093/ehjcr/ytag665

September 4, 2026European Heart Journal - Case ReportsOpen Access

Three rhythms in one presentation: atrial flutter, Torsades de Pointes, and complete heart block

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Key Points

To describe the mechanism and clinical management of concurrent atrial flutter, pause-dependent Torsades de Pointes, and complete atrioventricular block in an elderly patient.
Evaluated a man in his 80s presenting with progressive exertional dyspnoea and lower-limb oedema using 12-lead electrocardiography and continuous telemetry.
Delivered a single 200 J synchronized cardioversion shock and analyzed post-resuscitation conduction abnormalities.
Initial monitoring identified atrial flutter with slow ventricular response (rates down to 35 bpm) triggering pause-dependent Torsades de Pointes via a short–long–short sequence without electrolyte abnormalities or QT-prolonging drugs.
Post-cardioversion electrocardiogram showed sinus tachycardia with atrioventricular dissociation and a wide-QRS escape rhythm, establishing complete infra-Hisian heart block requiring permanent pacing.

Study Design

Type

Case Report (n=1)

Structured PICO

P

Population

A man in his 80s presenting with progressive exertional dyspnoea who developed atrial flutter, pause-dependent Torsades de Pointes, and complete heart block.

I

Intervention

200 J synchronized shock (cardioversion)

Implication

An educational case highlighting pause-dependent Torsades de Pointes triggered by a short-long-short sequence in a patient with atrial flutter and underlying infra-Hisian complete heart block.

Abstract

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Discussion

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Cite This Study

Nina George (2026) conducted a case report in Atrial flutter, Torsades de Pointes, and complete heart block (n=1). Synchronized cardioversion was evaluated.

synapsesocial.com/papers/6a9c00b46b95aff0620ec803 https://doi.org/10.1093/ehjcr/ytag665

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Three rhythms in one presentation: atrial flutter, Torsades de Pointes, and complete heart block

Figures

Key Points

Study Design

Structured PICO

Implication

Abstract

Discussion

Cite This Study

Three rhythms in one presentation: atrial flutter, Torsades de Pointes, and complete heart block

Figures

Key Points

Study Design

Structured PICO

Implication

Abstract

Discussion

Cite This Study

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