PMC5420044_01
Initial electrocardiogram revealing bradycardia with 2:1 atrioventricular block and prolonged QT with isolated premature ventricular contractions.
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Initial cardiac assessment revealed 2:1 atrioventricular block (atrial rate 120 and ventricular rate 60) and corrected QT of 690 milliseconds (Figure 1) with short episodes of TdP.
PMC5420044_02
PMC5420044_03
Timeline of significant events in months vs arrhythmia burden. ICD = implantable cardioverter-defibrillator; LCSD = left cardiac sympathetic denervation; PM = pacemaker; Tdp = torsades de pointes.
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With a regimen of ranolazine, mexiletine, phenytoin, diltiazem, and propranolol, we have reduced the patient's arrhythmia burden from >50 episodes per day to zero (Figure 2).
Electrocardiogram showing A-paced rhythm at a rate of 100 beats per minute with QTc of 595 msec.
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She continues to have prolonged QT with a QTc of 595 msec (Figure 3).