An Important Cause of Wide Complex Tachycardia

Abstract

A man in his 60s was admitted to the intensive care unit with necrotizing pancreatitis and biliary stenosis complicated by pneumonia, hypoxic respiratory failure, and convulsive seizures. The cardiology service was consulted to evaluate recurrent episodes of wide complex tachycardia observed on telemetry (Figure , A). The patient did not lose consciousness during these episodes.Question: What is the cause of this wide complex tachycardia? InterpretationThe electrocardiogram (ECG) strip (Figure , A) starts with 2 sinus beats conducted with normal PR interval, QRS duration and morphology, and QT interval. Then wide complex tachycardia initiates and terminates. The wide complex tachycardia peaks twist around the isoelectric baseline, consistent with torsades de pointes. 1 Of note, the QT interval in this patient is not prolonged, which is usually a prerequisite for torsades de pointes.