Sleep-Associated Torsades de Pointes: A Case Report

Torsades de Pointes (TdP) is a polymorphic ventricular tachycardia that occurs in the presence of an acquired or congenital long QT syndrome (LQTS). We present the case of a 57 year-old man with end-stage renal disease on methadone maintenance in which there occurred multiple episodes of TdP during sleep. The patient was found to have a QTc interval of 548 milliseconds, and the dysrhythmia was successfully treated with isoproterenol infusion and methadone substitution. It is surmised that the patient had a multifactorial, acquired LQTS that during somnolence, reached a critical threshold of QT prolongation to lead to the development of TdP.