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Related Experiment Videos

[Torsade de Pointes and demand endocavitary pacemaker. A case report].

J Pardo1, O Novoa, R González

  • 1Departamento de Enfermedades Cardiovasculares, Pontificia Universidad Católica de Chile.

Revista Medica De Chile
|June 1, 1999
PubMed
Summary

A pacemaker adjustment successfully treated recurrent syncope and Torsade de Pointes in an elderly patient with aortic insufficiency. Increasing pacemaker rate shortened the QT interval, resolving dangerous ventricular tachycardia and syncopal episodes.

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Geriatric Medicine

Background:

  • Severe aortic insufficiency presents complex management challenges, particularly in elderly patients.
  • Recurrent syncope can be a debilitating symptom requiring thorough investigation.
  • Atrioventricular block necessitates pacing interventions to maintain adequate heart rate.

Observation:

  • An 81-year-old female with aortic insufficiency experienced recurrent syncope attributed to atrioventricular block.
  • Despite pacemaker implantation, the patient had a subsequent syncopal episode with a prolonged QT interval.
  • Electrocardiogram monitoring revealed self-limited polymorphic ventricular tachycardia (Torsade de Pointes) during pacemaker rhythm.

Findings:

  • Pacemaker reprogramming to a higher frequency effectively shortened the QT interval from 0.73 to 0.56 seconds.

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  • The adjusted pacemaker settings eliminated episodes of Torsade de Pointes and syncopal recurrences.
  • This intervention demonstrated a significant improvement in the patient's clinical status and safety.

    • Implications:

    • Pacemaker programming adjustments can be a crucial therapeutic strategy for managing Torsade de Pointes in specific patient populations.
    • Understanding the relationship between pacemaker function, QT interval, and ventricular arrhythmias is vital for patient care.
    • This case highlights the importance of comprehensive electrocardiographic monitoring and tailored pacemaker management in elderly patients with cardiovascular conditions.