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This report describes a case of a patient with long QT syndrome (LQTS) with recurrent episodes of torsades de pointes (TdP). Use of biventricular pacing (BiVP) resulted in a shorter QT interval and a shorter T-peak-end interval and prevented further episodes of TdP. These findings suggest that BiVP may be helpful in patients with LQTS and refractory TdP., (©2011, The Authors. Journal compilation ©2011 Wiley Periodicals, Inc.)

This 24-year-old woman had incessant polymorphic ventricular tachycardia (PVT) during week 24 of her pregnancy and received over 200 implantable cardioverter-defibrillator discharges. She failed to respond to quinidine, magnesium, isoproterenol, amiodarone, esmolol, and cilostazol during her PVT storm, although her dramatic response to verapamil was consistent with the diagnosis of short-coupled variant of torsades de pointes. The case illustrated the utility of extracorporeal membrane oxygenation during refractory PVT, while attempting diagnostic and therapeutic pharmacologic maneuvers., (©2010, The Authors. Journal compilation ©2010 Wiley Periodicals, Inc.)

A 70-year-old woman presented with acute pancreatitis and new-onset QT prolongation with subsequent torsades de pointes. Coronary catheterization was performed and was unremarkable. After persistent QT prolongation, despite temporary atrial pacing, a permanent dual chamber cardioverter defibrillator was implanted. In addition to the QT prolongation, significant depression in the left ventricular function was noted. Both resolved once the pancreatitis abated.

Polymorphous ventricular tachyarrhythmias (PVTA) in the absence of structural heart disease form a particularly important target for comprehensive research. They occur in young, healthy children and young adults and most probably cover several underlying electrophysiological abnormalities. We individualized two syndromes, namely catecholaminergic ventricular tachyarrhythmias, and torsade de pointes (TDP) with a short coupling interval, but these two entities certainly represent only a part of the problem of idiopathic ventricular fibrillation. Having the implanted defibrillator as a therapeutic umbrella for those patients who were fortunate enough to escape from sudden death is not sufficient. Too often in modern cardiology the therapeutic achievements tend to precede the process of diagnosis and comprehension. At least, the former should not preclude the latter, a situation that can be observed, for instance, when the favorable effect of a drug is evidenced before its mode of action was understood. At best, both progress together, provided we pay attention to adequately exploit the resources of modern technology.

Implantable cardioverter-defibrillators (ICDs) have been a successful adjunct to the management of arrhythmias in patients with Long QT syndrome (LQTS). In two patients, interactions between LQTS and the ICD were diagnosed and corrected. Oversensing of T waves was confirmed in the first, while in the second, the arrhythmia disappeared when T wave abnormalities improved after cessation of H2 blocker therapy. In patients with LQTS and an ICD, T wave oversensing should be considered. Interventions that may have an adverse effect on repolarization should be avoided.