A case of torsade de pointes in a patient with severe aortic stenosis during carotid endarterectomy

An 87-year-old man with severe aortic stenosis developed torsade de pointes (TdP) during carotid endarterectomy before carotid artery stenosis. By prompt resuscitation and medication including lidocaine and magnesium, the patient recovered without complications in spite of high risk for refractory cardiac arrest or brain infarction. There was no other history or laboratory data suggesting arrhythmia except elongation on preoperative electrocardiogram. Inhaled anesthetics, catecholamine and sympathetic nerve stimulation were possible causes of QT elongation and induce TdP. Particularly in a patient with carotid and cardiac diseases, cardiac arrest is critical. Therefore we should avoid exacerbating factors of QT elongation or TdP even if patients have no particular history of arrhythmia.