Recurrent Ventricular Arrhythmia From Acquired Long QT Syndrome Due to Alcohol-Related Electrolyte Depletion

Electrolyte depletion during alcohol withdrawal can cause acquired long QT syndrome (LQTS), leading to torsades de pointes (TdP) and ventricular fibrillation (VF) CASE SUMMARY: A 64-year-old man with a history of heavy alcohol use presented with syncope. Evaluation revealed a prolonged QTc interval of 511 ms, along with hypokalemia (K⁺ level: 3.09 mmol/L) and hypomagnesemia (Mg²⁺ level: 0.70 mmol/L). Telemetry documented TdP and VF during an in-hospital syncopal episode. Genetic test results for congenital LQTS were negative. Aggressive potassium and magnesium repletion stabilized his rhythm, shortening the QTc interval to 460 ms.

Alcohol withdrawal can cause marked QTc prolongation via electrolyte disturbances, precipitating TdP and VF. This under-recognized complication highlights the need for vigilant monitoring and prompt electrolyte correction to prevent fatal arrhythmias.

In acute alcohol withdrawal syndrome , severe hypokalemia and hypomagnesemia can induce acquired LQTS, resulting in TdP and VF. Management includes defibrillation, magnesium and potassium repletion, and avoiding QT-prolonging drugs. Implantable cardioverter-defibrillator placement is not indicated once electrolyte abnormalities are corrected.