Lethal Dance with Dialysis – A Case of Silent Long QT Syndrome

Fatal arrhythmia is the leading cause of mortality in chronic haemodialysis patients. Long QT syndrome is responsible for polymorphic ventricular tachycardia known as Torsade de Pointes. Classically, long QT syndromes were divided into congenital and acquired; however ‘silent' variants, in which patients remain asymptomatic until exposed to a drug or electrolyte disturbance precipitating the arrhythmia, have now been recognized. Management of these cases may prove especially difficult in situations where exposure to the precipitating factor cannot be avoided, such as in chronic haemodialysis patients. We present a case of a silent long QT syndrome which resulted in multiple cardiac arrests upon exposure to dialysis and required an insertion of implantable-cardioverter defibrillator.