Year 2024 / Volume 116 / Number 3
Letter
Torsade de pointes secondary to long QT syndrome after intragastric balloon placement. A rare but severe complication

169-170

DOI: 10.17235/reed.2023.9613/2023

Marta García-Calonge, María Helena González-Sánchez, Daniel Muíño-Domínguez, Pablo Flórez-Díez,

Abstract
The obesity pandemic is becoming one of the most prevalent diseases nowadays. There is a wide spectrum of treatment, ranging from hygienic-dietary measures to bariatric surgery. Endoscopic intragastric balloon placement is becoming increasingly more frequent, due to its technical simplicity, safety and short-term success(1). Although complications are rare some can be severe, so pre-endoscopic evaluation must be carried out carefully. A 43-year-old woman with a history of grade I obesity (BMI 32.7) had an Orbera® intragastric balloon implanted successfully. After the procedure she presented frequent nausea and vomiting, partially controlled with antiemetics. She attended the Emergency Department(ED) with a persistent emetic syndrome - oral intolerance and short-term loss of consciousness(syncope), for which she was admitted. Lab tests showed metabolic alkalosis with severe hypokalemia(K+ 1.8mmol/L), so fluid therapy was initiated for hydroelectrolytic replacement. During the patient’s stay in the ED, two episodes of polymorphic ventricular tachychardia “Torsades de Pointes” (PVT-TDP) occurred, leading to cardiac arrest and requiring electrical cardioversion to restore sinus rhythm, in addition to a temporary pacemaker placement. Telemetry showed a corrected QT interval of >500ms, compatible with Long QT Syndrome(LQTS). Once the patient was hemodynamically stabilized a gastroscopy was performed. The intragastric balloon located in the fundus was removed using an extraction kit, puncturing and aspirating 500ml of saline solution, and extracting the collapsed balloon without any complications. The patient achieved an adequate oral intake afterwards, and no recurrence of emetic episodes were noticed. Previous ECGs revealed a prolonged QT interval and a genetic study confirmed a congenital type 1 LQTS. Treatment was initiated with beta-blockers and a bicameral automatic defibrillator was implanted in order to prevent recurrences. Intragastric balloon placement is generally a safe procedure, serious complications present in 0.70% of cases(2). It is essential to have a proper pre-endoscopic evaluation, including patient's medical history and comorbidities. Episodes of PVT-TDP may present precipitated by certain medications (eg. metoclopramide) or hydroelectrolytic imbalances (eg, hypokalemia)(3). A standardized evaluation of ECG before intragastric balloon placement may be useful to prevent these rare but serious complications.
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References
1. Yorke E, Switzer NJ, Reso A, et al. Intragastric Balloon for Management of Severe Obesity: a Systematic Review. Obes Surg 2016; 26:2248.
2. Espinet Coll E, Del Pozo García AJ, Turró Arau R, et al. Spanish Intragastric Balloon Consensus Statement (SIBC): practical guidelines based on experience of over 20 000 cases. Rev Esp Enferm Dig. 2023 Jan;115(1):22-34.
Al-Khatib SM, Stevenson WG, Ackerman MJ, et al. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2018 Oct 2;72(14):1677-1749. doi: 10.1016/j.jacc.2017.10.053.
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García-Calonge M, González-Sánchez M, Muíño-Domínguez D, Flórez-Díez P. Torsade de pointes secondary to long QT syndrome after intragastric balloon placement. A rare but severe complication. 9613/2023


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Publication history

Received: 20/03/2023

Accepted: 14/04/2023

Online First: 28/04/2023

Published: 04/03/2024

Article Online First time: 39 days

Article editing time: 350 days


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