Key result
Overdrive pacing, electrolyte repletion, and fluconazole cessation resolve incessant TdP in a single patient.
Case Report (n=1)
Overdrive transvenous pacing, combined with electrolyte repletion and discontinuation of the offending agent, successfully managed incessant torsades de pointes in a patient with acquired long QT syndrome.
May inform acute management of drug-induced torsades; hypothesis-generating and should not yet change practice.
A 75-year-old man presented to the emergency department (ED) for syncope and was found to have intermittent runs of torsades de pointes (TdP). The patient had a medical history significant for disseminated coccidiomycosis and was on prophylactic fluconazole. Forty-eight hours prior to presentation, the patient had intractable nausea and vomiting and was unable to take anything orally. He eventually presented to the ED with severe hypokalaemia and hypomagnesaemia with repeat symptomatic runs of TdP, which required overdrive transvenous pacing. During the patient''s admission, his electrolytes were aggressively replete. Fluconazole was discontinued, and prior to discharge, the patient recovered fully with ECGs showing a normalisation of the QT interval.
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Overbey et al. (2013) conducted a case report in Incessant torsades de pointes (n=1). Overdrive transvenous pacing, electrolyte repletion, and fluconazole discontinuation was evaluated on Recovery and normalisation of the QT interval. Overdrive transvenous pacing, aggressive electrolyte repletion, and fluconazole discontinuation led to full recovery and normalisation of the QT interval in a patient with incessant torsades de pointes.
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