Torsades de pointes and aborted sudden death after implantation of a cardioverter defibrillator.

Recent publications have demonstrated that the implantable cardioverter defibrillator (ICD) improves survival in patients with ventricular tachycardia (VT) or fibrillation (VF) by reducing arrhythmic death. We report the case of a patient with a history of an old myocardial infarction and a left ventricular dysfunction, who presented four episodes of syncope associated with a hemodynamically not well tolerated sustained 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 pointes that sometimes degenerate into VF. The ICD delivered 64 adequate and well-tolerated shocks during 10 hours before and during the hospital admission. We programmed a VVI pacing rate at 65 bpm and no more arrhythmia was observed. The left ventricular ejection fraction was not altered afterwards. In conclusion, we experienced the temporary efficacy of the ICD in the treatment of incessant torsades de pointes, without myocardial injury.