QTc Prolongation in Stress-Induced Cardiomyopathy: A Case of Stabilization With Temporary High-Rate Pacing

Stress-induced cardiomyopathy (SCMP) is a transient cardiac syndrome often mimicking acute coronary syndrome. It is commonly associated with QT prolongation and can lead to serious dysrhythmias.

A 73-year-old man with severe chronic obstructive pulmonary disorder developed SCMP during an acute chronic obstructive pulmonary disorder exacerbation, complicated by marked QTc prolongation (>650 ms) and recurrent pulseless polymorphic ventricular tachycardia. Invasive coronary angiography showed no obstructive coronary artery disease. Arrhythmias persisted despite electrolyte correction. Ultimately, pacing at 100 beats/min shortened QTc and prevented arrests.

Although often self-limiting, stress cardiomyopathy may cause QT prolongation and arrhythmias. An underutilized therapy is high-rate pacing, which shortens QT and reduces early afterdepolarizations.

QT prolongation is not uncommon in SCMP, and severe prolongation often occurs, predisposing to polymorphic ventricular tachycardia and cardiac arrest. High-rate pacing is a highly effective, underutilized tool for acute management of severe QTc prolongation with associated ventricular tachycardia.