PMC7395991_01
Sinus rhythm with first-degree AV block, left bundle branch block pattern, and delayed QRS transition zone. QTc interval was not prolonged when corrected to the left bundle branch block (LBBB).
CRIC2020-8889769.001.jpg
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fig1
Electrocardiogram (ECG) showed sinus rhythm (Figure 1), first-degree AV block, left bundle branch block (LBBB) pattern, a wide QRS complex as a result of the left bundle branch block, and a delayed QRS transition zone; QTc interval was not prolonged according to when corrected to the LBBB. (LBBB;QTcH = 458 + 1.75 x (100 - 60) = 528 ms, final QTc = QTcH - 120 x 0.5 = 364 ms, QTc = 468).
(a) Torsades De Pointes, first episode in the hospital. (b) Setting the ICD at 100 beats per minute. (c) Torsade De Pointes after the replacement of ICD. (d) Dual AV-paced normal ECG by discharge time.
CRIC2020-8889769.002.jpg
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fig2
Overnight, the patient was shocked for multiple runs of TdP and V-Tach as shown in Figure 2(a). ICD was set at 100 beats per minute on DDD mode (Figure 2(b)). TdP which he was shocked for (Figure 2(c)). Thus, quinidine dose was increased to 648 every 12 hours. After 7 days of initial presentation and 48 hours of episodes free, the patient was discharged home (Figure 2(d)) (QTcH = 420 + 1.75(100 - 60) = 490 ms, final QTc = QTcH - 180 x 0.5 = 400 ms).