Torsade de pointes with short coupling interval

Torsade de pointes (TdP), a ventricular tachycardia (VT) with the peaks of QRS complexes twisting around the iso-electric baseline and progressive amplitude and polarity variations, is mostly associated with long (congenital or acquired) QT syndromes (LQTS) and long coupling intervals of the initiating complex. We describe a patient with variant, short-coupled TdP, a normal QTc interval and without demonstrable structural heart disease. Mechanisms remain unclear but there may be a relationship with autonomic nervous system imbalance. Since anti-arrhythmic drug efficacy is uncertain, ICD-implantation seems the first-line therapy. If ventricular arrhythmia recurs despite drug therapy, catheter-ablation of initiating premature ventricular beats may be warranted