QRS alteration-induced torsade de pointes in a patient with an artificial pacemaker and hypokalemia

The present patient demonstrated torsade de pointes (TdP) after a pacemaker implantation without a decrease in heart rate or pacemaker malfunction. Marked QT prolongation and TdP were closely related to alteration of the depolarization pattern (appearance of junctional rhythm). Resetting the pacemaker to a rate that inhibited spontaneous rhythm was effective in preventing TdP.