Arrhythmic storm: Short-coupled variant torsade de pointes.

Area of Science:

• Cardiology
• Electrophysiology

Background:

• A 49-year-old woman presented with recurrent, life-threatening polymorphic ventricular tachycardia (torsade de pointes) and ventricular fibrillation.
• Initial presentation in 1996 was managed with irregular amiodarone, with the patient refusing cardioverter-defibrillator implantation.
• No structural heart disease or iatrogenic causes were identified, and baseline electrocardiogram (ECG) was normal.

Observation:

• The patient experienced a second arrhythmic storm in 2014, refractory to antiarrhythmic drugs and exacerbated by ventricular pacing.
• Frequent, short-coupled ventricular extrasystoles (<300 ms) preceded the tachycardia episodes.
• Isoprenaline infusion temporarily stabilized the heart rhythm.

Findings:

• A diagnosis of short-coupled variant torsade de pointes was established, a rare condition characterized by specific ECG findings and triggers.
• This variant is distinct from other forms of torsade de pointes due to its association with short-coupled ventricular extrasystoles and absence of congenital long QT syndrome.

Implications:

• Successful management included cardioverter-defibrillator implantation and treatment with verapamil, leading to sustained arrhythmia-free survival.
• This case underscores the importance of recognizing and managing short-coupled variant torsade de pointes, particularly in patients with unexplained ventricular arrhythmias.
• The findings suggest that verapamil may be a valuable therapeutic option for this specific arrhythmia subtype.