Key result
IV magnesium plus pacing at 100 beats/min resolves post-transplant torsades de pointes and shortens QT.
Why the study?
Macroscopic T-wave alternans is a rare manifestation of severe QT prolongation and a harbinger of impending torsades de pointes.
Case Report (n=1)
No
Highlights the recognition of macroscopic T-wave alternans as a sign of impending torsades de pointes and demonstrates successful management using intravenous magnesium and overdrive pacing at 100 beats/min.
Answers are grounded in this paper and cite their sources.
Case of post-transplant torsades in a paced patient supports acute magnesium and overdrive pacing; leaves open broader prevention strategies.
CASE SUMMARY: A 54-year-old woman with end-stage renal disease and a dual-chamber pacemaker for high-grade atrioventricular block underwent deceased donor kidney transplantation. Her postoperative course was complicated by marked QT prolongation and recurrent torsades de pointes (TdP), resulting in cardiac arrest. Postarrest electrocardiogram demonstrated macroscopic T-wave alternans-a rare manifestation of severe QT prolongation. Treatment with intravenous magnesium and reprogramming her pacemaker to a lower rate limit of 100 beats/min resulted in electrical stability and improvement of the QT interval. TAKE-HOME MESSAGE: This case underscores recognition of macroscopic T-wave alternans as a harbinger of impending TdP, vigilant QT monitoring, and evidence-based TdP management.
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Endo et al. (2026) conducted a case report in Marked QT prolongation, macroscopic T-wave alternans, and recurrent torsades de pointes after deceased donor kidney transplantation (n=1). Intravenous magnesium and pacemaker reprogramming to a lower rate limit of 100 beats/min was evaluated on Electrical stability and improvement of the QT interval. IV magnesium and pacemaker reprogramming to a lower rate limit of 100 beats/min achieved electrical stability and QT improvement after post-transplant torsades de pointes.
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