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The present patient demonstrated torsade de pointes (TdP) after a pacemaker implantation without a decrease in heart rate or pacemaker malfunction. Marked QT prolongation and TdP were closely related to alteration of the depolarization pattern (appearance of junctional rhythm). Resetting the pacemaker to a rate that inhibited spontaneous rhythm was effective in preventing TdP.

QRS Alteration-induced Torsade de Pointes in a Patient With an Artificial Pacemaker and Hypokalemia