Iatrogenic torsades de pointes induced by a transient pacemaker sensing failure in a patient with a prolonged QT interval

Abstract

Prolonged QT syndrome predisposes patients to ventricular arrhythmias such as Torsades de Pointes (TdP). Elderly patients on polypharmacy are at higher risk.

We present the case of a 65-year-old female patient with syncope and prolonged QT of multifactorial etiology (polypharmacy with escitalopram, ciprofloxacin, and carvedilol) who, following the implantation of a temporary pacemaker for arrhythmia prevention, developed Torsades de Pointes. The event was triggered by an R-on-T phenomenon secondary to a ventricular sensing failure of the device, which led to the ventricular arrhythmia. Timely detection through monitoring allowed technical correction by adjusting the sensitivity and repositioning the electrode, thereby achieving clinical stabilization.

This case underscores the critical need for close monitoring of the programming parameters of temporary pacemakers in acute care units and for consideration of the polypharmacy complications in patients, as they can trigger life-threatening arrhythmias.