title: Torsade de pointes in a patient with complete atrioventricular block and pacemaker failure, misdiagnosed with epilepsy.
abstract: A case of torsade de pointes (TdP) with complete atrioventricular block and pacemaker failure that was misdiagnosed as epilepsy is presented herein. An 82-year-old female with recurrent seizure-like attacks showed epileptiform discharge during an electroencephalogram recording. A long QT interval and severe hypokalemia induced runs of TdP, which was related to pacemaker lead fracture, was detected during Holter recording and accompanied with episodes of seizures. After a DDD pacemaker with a new ventricular lead was replaced, there was no recurrence of any seizure-like attacks. Bradycardia-mediated TdP associated with complete atrioventricular block should not be missed in patients with recurrent seizure-like attacks even after pacemaker implantation.
authors.affiliation: Department of Cardiology, 2nd Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China. Electronic address: diovan@medmail.com.cn.
authors.forename: Si-Yu
authors.initials: SY
authors.lastname: Cai
authors.affiliation: Department of Cardiology, 2nd Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
authors.forename: Shen-Feng
authors.initials: SF
authors.lastname: Ye
authors.affiliation: Department of Cardiology, 2nd Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
authors.forename: Xiang
authors.initials: X
authors.lastname: Wu
authors.affiliation: Department of Cardiology, 2nd Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
authors.forename: Mei-Xiang
authors.initials: MX
authors.lastname: Xiang
authors.affiliation: Department of Cardiology, 2nd Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
authors.forename: Jian-An
authors.initials: JA
authors.lastname: Wang
mesh_terms: D000369:Aged, 80 and over; D054537:Atrioventricular Block / Q000150:complications / Q000175:diagnosis* / Q000517:prevention & control*; D004562:Electrocardiography / Q000379:methods; D004827:Epilepsy / Q000175:diagnosis* / Q000209:etiology; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D011475:Prosthesis Failure; D016171:Torsades de Pointes / Q000175:diagnosis* / Q000209:etiology*
keywords: Complete atrioventricular block; Pacemaker; Seizures; Torsade de pointes