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Delayed QT prolongation and electrical storm following cardioversion.

Edward Dababneh1, Dylan Young1, Sachin Nayyar1

  • 1Department of Cardiology, Division of Specialist Medical Services, Gold Coast Hospital and Health Services, Southport, QLD 4215, Australia; Department of Medicine, Griffith University School of Medicine, Parklands Dr, Southport, QLD 4215, Australia.

Journal of Electrocardiology
|September 29, 2025
PubMed
Summary
This summary is machine-generated.

Delayed Torsades de Pointes (TdP) occurred 66 hours after electrical cardioversion in a patient with atrial fibrillation. This highlights a critical post-cardioversion window for dangerous arrhythmias in high-risk patients.

Keywords:
Electrical cardioversionOsimertinibQTc prolongationSotalolTorsades de pointes

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Area of Science:

  • Cardiology
  • Electrophysiology

Background:

  • Electrical cardioversion is a common treatment for atrial fibrillation.
  • QT prolongation and Torsades de Pointes (TdP) are known risks associated with cardioversion and certain medications.

Purpose of the Study:

  • To report a case of delayed Torsades de Pointes (TdP) following electrical cardioversion.
  • To emphasize the vulnerable window for proarrhythmia post-cardioversion.

Main Methods:

  • A case study of a 68-year-old woman who developed delayed TdP after electrical cardioversion.
  • Management included Sotalol discontinuation, electrolyte correction, resuscitation, and temporary overdrive pacing.

Main Results:

  • The patient experienced bradycardia-associated TdP approximately 66 hours post-cardioversion.
  • QTc interval normalized with pacing, and no further arrhythmic events occurred.

Conclusions:

  • A vulnerable window for proarrhythmia exists in the days following cardioversion, especially in patients with multiple QT-prolonging risk factors.
  • Extended ECG monitoring and consideration of early pacing are crucial for preventing life-threatening arrhythmias in high-risk individuals.