A Unique Interplay of Multiple Predisposing Factors Culminating in a Catastrophic QT Prolongation

Area of Science:

• Cardiology
• Clinical Medicine
• Genetics

Background:

• Implantable cardioverter-defibrillators (ICDs) are crucial for managing long QT syndrome (LQTS) and preventing sudden cardiac arrest.
• Identifying reversible causes of QT prolongation is essential for appropriate patient management.

Observation:

• A female patient presented with QT prolongation due to multiple reversible factors: medications (antidepressants, antidiarrheals, antiemetics, antihistamines), post-bariatric surgery malabsorption, and electrolyte imbalances.
• The patient experienced polymorphic ventricular tachycardia and cardiac arrest, successfully resuscitated, necessitating an ICD.
• A history suggestive of probable congenital LQTS, including childhood syncope and family history of seizures, further supported ICD placement.

Findings:

• The case demonstrates a complex interplay of acquired and potentially congenital factors leading to life-threatening QT prolongation.
• Multiple medications and physiological changes post-bariatric surgery significantly contributed to the observed QT prolongation and subsequent cardiac events.
• The patient's presentation underscores the challenges in managing LQTS in individuals with multiple comorbidities.

Implications:

• This case emphasizes the critical need to thoroughly investigate reversible causes of QT prolongation, especially in patients with a history of bariatric surgery.
• It highlights the potential risks of catastrophic QT prolongation in the morbidly obese population undergoing bariatric procedures.
• The successful ICD implantation in this complex case reinforces its role in secondary prevention of sudden cardiac death in high-risk LQTS patients.