Bradycardia-Induced Torsades de Pointes in Atrioventricular Block

Abstract

Bradycardia is known to prolong QT interval. Persistent bradycardia and high-grade atrioventricular (AV) block may lead to persistently prolonged QTc interval with a risk for life-threatening ventricular arrhythmias, which needs addressing the underlying cause.We present the case of a patient with persistent sinus bradycardia with a high-grade AV block leading to persistently prolonged QTc without any reversible etiology that resulted in torsades de pointes. The underlying treatment involved shortening the QTc by increasing the heart rate to prevent any further episodes of polymorphic ventricular tachycardia.

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“…Some reports (17,18) have shown that AV block-induced cardiac electrical and structural remodeling predisposes the heart to TdP in an AV dog model. Bhattad et al (2023) (19) described that tachycardia usually shortens the QTc interval, but the adjustment is not instantaneous. Bradycardia increases the risk of QTc prolongation and therefore the risk for torsade de point.…”

“…Bhattad et al. (2023) ( 19 ) described that tachycardia usually shortens the QTc interval, but the adjustment is not instantaneous. Bradycardia increases the risk of QTc prolongation and therefore the risk for torsade de point.…”