title: Overdrive pacing in a patient with incessant torsades de pointes.
abstract: A 75-year-old man presented to the emergency department (ED) for syncope and was found to have intermittent runs of torsades de pointes (TdP). The patient had a medical history significant for disseminated coccidiomycosis and was on prophylactic fluconazole. Forty-eight hours prior to presentation, the patient had intractable nausea and vomiting and was unable to take anything orally. He eventually presented to the ED with severe hypokalaemia and hypomagnesaemia with repeat symptomatic runs of TdP, which required overdrive transvenous pacing. During the patient''s admission, his electrolytes were aggressively replete. Fluconazole was discontinued, and prior to discharge, the patient recovered fully with ECGs showing a normalisation of the QT interval.
authors.affiliation: Department of Internal Medicine, Naval Medical Center San Diego, San Diego, California, USA.
authors.forename: Adam N
authors.initials: AN
authors.lastname: Overbey
authors.forename: Andrea
authors.initials: A
authors.lastname: Austin
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Seidensticker
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Lin
mesh_terms: D000368:Aged; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D004562:Electrocardiography; D006801:Humans; D008297:Male; D016171:Torsades de Pointes / Q000503:physiopathology / Q000628:therapy*