TORSADES-DE-POINTES AND ABORTED SUDDEN-DEATH AFTER IMPLANTATION OF A CARDIOVERTER-DEFIBRILLATOR

Recent publications have demonstrated that the implantable cardioverte r defibrillator (ICD) improves survival in patients with ventricular t achycardia (VT) or fibrillation (VF) by reducing arrhythmic death. We report the case of a patient with a history of an old myocardial infar ction and a left ventricular dysfunction, who presented four episodes of syncope associated with a hemodynamically not well tolerated sustai ned VT, who had easy inductible clinical VT during electrophysiologic study and required an ICD. After a follow-up of 2 months, the patient presents a complete AV block and multiple episodes of torsades de poin tes that sometimes degenerate into VF. The ICD delivered 64 adequate a nd well-tolerated shocks during 10 hours before and during the hospita l admission. We programmed a VVI pacing rate at 65 bpm and no more arr hythmia was observed. The left ventricular ejection fraction was not a ltered afterwards. In conclusion, we experienced the temporary efficac y of the ICD in the treatment of incessant torsades de pointes, withou t myocardial injury.