Cardiac Arrest After Deceased Donor Kidney Transplant

A 54-year-old woman with end-stage renal disease and a dual-chamber pacemaker for high-grade atrioventricular block underwent deceased donor kidney transplantation. Her postoperative course was complicated by marked QT prolongation and recurrent torsades de pointes (TdP), resulting in cardiac arrest. Postarrest electrocardiogram demonstrated macroscopic T-wave alternans-a rare manifestation of severe QT prolongation. Treatment with intravenous magnesium and reprogramming her pacemaker to a lower rate limit of 100 beats/min resulted in electrical stability and improvement of the QT interval.

This case underscores recognition of macroscopic T-wave alternans as a harbinger of impending TdP, vigilant QT monitoring, and evidence-based TdP management.