Case report: Torsade de pointes induced by the bigeminy result from retrograde ventriculoatrial activation in VVI pacing and resolved by intentional atrial pacing

• DOI: 10.3389/fcvm.2023.1156658
• Publication Date: 2023-05-24T05:41:11Z
• Authors: Song-Yun Chu; Qin-Hui Sheng; Qiu-Ping Shi; Lin Qiu; Lin Wu; Jing Zhou
• Keywords: Cardiac Resynchronization Therapy in Heart Failure; Heart rate; Cardiology; Bigeminy; Catheter Ablation of Cardiac Arrhythmias; Heart failure; Ventricular pacing; Cardiovascular Medicine; torsade de pointes (TdP); Long-QT Syndrome; 03 medical and health sciences; 0302 clinical medicine; Health Sciences; implantable cardioversion defibrillator; Bradycardia; Diseases of the circulatory (Cardiovascular) system; Anesthesia; Internal medicine; Ventricular tachycardia; Molecular Mechanisms of Cardiac Arrhythmias; pacemaker; RC666-701; Blood pressure; Medicine; long QT syndrome (LQTS); atrioventricular sequential pacing; Cardiology and Cardiovascular Medicine; Cardiac pacing; Atrioventricular block

IntroductionWhile pacing has been used for long QT syndrome (LQTs), the optimal pacing modality is controversial.CaseWe report a woman with bradycardia and a recently implanted single-chamber pacemaker experienced multiple syncope. No device dysfunction was found. Multiple Torsade de Pointes (TdP) induced by the bigeminy result from retrograde ventriculoatrial (VA) activation in VVI pacing were demonstrated in the scenario of previously unidentified LQTs. Replacement for a dual-chamber ICD and intentional atrial pacing eliminated the VA conduction and symptoms.ConclusionPacing without atrioventricular sequence might be catastrophic in LQTs. Atrial pacing and atrioventricular synchrony should be highlighted.