Sleep-Associated Torsades de Pointes: A Case Report

INTRODUCTION: Torsades de Pointes is a major cause of sudden cardiac death, with many causes identified, both acquired and congenital. CASE REPORT: We present a 57 year-old man presenting to the Emergency Department with multiple recurrent episodes of a malignant dysrhythmia that was likely Torsades de Pointes occurring during sleep. His QT and QTc were prolonged on initial electrocardiogram, and multiple contributory factors are postulated, including methadone maintenance, hemodialysis, and episodes of bradycardia during sleep. DISCUSSION: Sleep has been found to be associated with both bradycardia and a prolongation in QTc. This phenomenon was likely a crucial contributor in this patient for developing recurrent Torsades de Pointes during somnolence