SHM Converge Scientific Abstract ePoster Gallery-Unmasking the Unexpected: A Case of Torsade's De Pointes and Cardiac Arrest in a Previously Healthy Young Patient

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This case report describes a 25-year-old woman with no prior medical history who experienced recurrent unexplained syncope over several years. Her episodes were often preceded by palpitations, dizziness, confusion, diaphoresis, and in one instance urinary incontinence, with occasional head trauma from sudden collapse. Initial emergency evaluations, including physical exams, ECGs, and laboratory tests, were normal. Further workup showed a 24-hour Holter monitor with PVC trigeminy and a normal echocardiogram with preserved cardiac structure and function. An electrophysiology study was also unrevealing, showing normal intervals and no inducible arrhythmias, though sporadic PVCs were observed.<br /><br />Because the cause remained unclear, a loop recorder was implanted. Three months later, during a fourth syncopal event, the device captured Torsades de Pointes progressing to ventricular fibrillation. She then received an emergent single-lead implantable cardioverter-defibrillator (ICD) for secondary prevention. Genetic testing identified variants in the PDLIM3 and SLCA2 genes, though their clinical significance remains uncertain. After treatment, she continued to have episodes of non-sustained ventricular tachycardia, requiring intensification of antiarrhythmic therapy, but overall her prognosis improved.<br /><br />The report highlights that idiopathic Torsades de Pointes can occur in patients with structurally normal hearts and without typical ECG abnormalities or obvious triggers such as electrolyte disturbances or prolonged QT interval. It also emphasizes the potential role of premature ventricular contractions in triggering malignant ventricular arrhythmias and the importance of long-term rhythm monitoring when syncope remains unexplained. The case underscores the need for secondary prevention with ICD therapy and further research into genetic contributors and mechanisms underlying idiopathic ventricular arrhythmias.

Asset Subtitle

Andrea Rodriguez Jimenez

Meta Tag

Author List Anas Bizanti, Andrea Rodriguez Jimenez, Juan Carlos Rivera-Martinez

Category Clinical Vignettes

Concept Torsades de Pointes

Concept Premature Ventricular Contractions

Concept Ventricular Fibrillation

Concept Electrocardiogram

Concept Syncope

Distinguished Non-Finalist

Presenter Organization Lakeland Regional Health

Presenting Author Andrea Rodriguez Jimenez

Track Adult

Keywords

syncope

Torsades de Pointes

ventricular fibrillation

implantable loop recorder

implantable cardioverter-defibrillator

premature ventricular contractions

idiopathic ventricular arrhythmia

electrophysiology study

genetic testing

secondary prevention

Torsades de Pointes

Premature Ventricular Contractions

Ventricular Fibrillation

Electrocardiogram

Syncope