?url_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Adc&rft.title=Nearly+Fatal+Torsade+de+Pointes+with+Sotalol&rft.creator=Strohmer%2C+Bernhard&rft.creator=Schernthaner%2C+Christiana&rft.creator=Pichler%2C+Maximilian&rft.subject=Indian+Pacing+and+Electrophysiology+Journal&rft.description=A+75-year-old+woman+with+paroxysmal+atrial+fibrillation+(AF)+experienced+recurrent+seizures+at+home.+Holter+monitoring+(each+line+50+sec)+showed+repetitive+runs+of+torsade+de+pointes+(TdP)%2C+degenerating+into+ventricular+fibrillation+and+ventricular+tachycardia+(VT).+Abrupt+asytole+heralded+end+of+electrical+activity+and+life.+Amazingly%2C+6+min+after+cardiac+arrest+a+slow+ventricular+escape+rhythm+arose+spontaneously+without+resuscitation.+At+baseline%2C+repolarisation+was+markedly+prolonged+(QTc%3E660+msec)+and+ventricular+bigeminy+triggered+short+bursts+of+TdP+after+%E2%80%9Elong-short%E2%80%9D+sequences.+No+hypokalemia+or+renal+dysfunction+was+present.+Following+intensive+treatment+(sedation%2C+magnesium+iv%2C+acceleration+of+heart+rate)+the+patient+recovered+without+neurological+deficit.+Except+left+ventricular+hypertrophy+and+incomplete+left+bundle+branch+block+the+results+of+angiography%2C+electrophysiological+study+and+ajmaline+test+were+normal.+There+was+no+family+history+of+sudden+death.+Months+ago+a+cardioversion+attempt+with+ibutilide+triggered+polymorphic+VT.+Therapy+with+metoprolol+(95+mg%2Fday)+was+discontinued+due+to+poor+efficacy+of+rhythm+control.+Thus%2C+sotalol+(240+mg%2Fday)+was+initiated+in-hospital+without+signs+of+QT+prolongation+within+4+days+(QT+416%2C+QTc+432+msec).+However%2C+two+weeks+later+the+patient+presented+with+an+%E2%80%9Cidiosyncratic%E2%80%9D+proarrhythmic+response+to+sotalol+(IKr-blocking+drug)+and+a+life-threatening+arrhythmia.1+There+is+growing+evidence+that+drug-induced+long+QT+syndrome+(LQTS)+may+be+due+to+%22silent%22+mutations+on+LQT+genes.2%2C3+Although+not+proven+by+molecular+analysis%2C+our+case+seems+to+resemble+a+subclinical%2C+inherited+form+of+LQTS+that+makes+the+patient+vulnerable+to+the+QT-prolonging+effects+of+a+variety+of+cardiac+and+noncardiac+drugs.+The+concept+of+%E2%80%9Crepolarization+reserve%E2%80%9D+suggests+that+any+factor+that+impairs+the+repolarizing+currents+renders+TdP+very+likely+when+IKr-blocking+drugs+are+used.+Avoiding+torsadogenic+drugs+should+basically+prevent+recurrence+of+TdP.+However%2C+an+implantable+cardioverter-defibrillator+was+placed+for+safety+reasons.4+During+a+follow-up+of+more+than+two+years+a+few+non-sustained+episodes+occurred%2C+the+longest%2C+a+short-coupled+polymorphic+VT+lasted+for+25+beats+resulting+in+a+diverted+shock..%0A&rft.publisher=Indian+Pacing+and+Electrophysiology+Group&rft.contributor=Singh%2C+Balbir&rft.contributor=Lokhandwala%2C+Yash&rft.contributor=Francis%2C+Johnson&rft.contributor=Gupta%2C+Anup&rft.date=2003-10&rft.type=Journal+(Paginated)&rft.type=PeerReviewed&rft.format=text%2Fhtml&rft.identifier=http%3A%2F%2Fcogprints.org%2F4253%2F1%2Fstrohmer.htm&rft.identifier=++Strohmer%2C+Bernhard+and+Schernthaner%2C+Christiana+and+Pichler%2C+Maximilian++(2003)+Nearly+Fatal+Torsade+de+Pointes+with+Sotalol.++%5BJournal+(Paginated)%5D+++++&rft.relation=http%3A%2F%2Fcogprints.org%2F4253%2F