An 8-year-old child with an implantable cardioverter-defibrillator for long QT syndrome experiences three appropriate shocks in 10 minutes for recurrent torsades de pointes despite maximum beta-blocker therapy. Which of the following is the most appropriate immediate intervention?
- A Intravenous magnesium sulphate
- B Intravenous lidocaine
- C Overdrive transvenous pacing at 100 bpm ✓
- D Left cardiac sympathetic denervation
Correct answer: C. Overdrive transvenous pacing at 100 bpm
Explanation
In electrical storm due to torsades de pointes in long QT syndrome, overdrive pacing (by increasing the pacing rate to shorten the QT interval) is an effective immediate strategy. Intravenous magnesium is first-line for acute torsades but is less effective for recurrent episodes in this setting. Lidocaine is a class IB agent and is not first-line for torsades. Left cardiac sympathetic denervation is a surgical option for refractory cases but not an immediate intervention.
Reference: Nelson Textbook of Pediatrics, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.