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.
Abstract:
A 68-year-old woman developed delayed QT prolongation and Torsades de Pointes (TdP) following electrical cardioversion for atrial fibrillation. Despite early discontinuation of Sotalol and optimal electrolyte replacement, she experienced bradycardia-associated TdP approximately 66 h post-cardioversion, requiring resuscitation and temporary overdrive pacing. QTc normalised with pacing, and no further episodes occurred. This case highlights a vulnerable window for proarrhythmia in the days following cardioversion, particularly in patients with multiple QT-prolonging risk factors. Extended ECG monitoring and consideration of early pacing may be critical in preventing life-threatening arrhythmias in high-risk individuals.
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