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Figure 3 Sinus Rhythm With Complete AVB (Post-Surgical AVB After Mitral Valve Replacement) Complicated by Torsade de Pointes

The top panel shows sinus rhythm with complete AVB (P waves marked with arrowheads). Note the narrow QRS escape with a rate of 42 beats/min, suggesting AV-nodal block. Also, note the LQT3-like (small and very late T waves) morphology of the QT segment. (Lower panel) The same patient later developed atrial flutter with very slow ventricular rate (36 beats/min). A series of short-long sequences, due to ventricular bigeminy, culminates in torsade de pointes.