Laparoscopic hysteroscopic tubal lavage triggers cardiac arrest from torsade de pointes in a patient with acquired long QT syndrome

Acquired long QT syndrome (aLQTS) is a disorder of delayed myocardial repolarization induced by medications, electrolyte disturbances, and other factors, with a significantly higher risk in females than in males. Various perioperative factors can trigger aLQTS, which may lead to cardiac arrest in severe cases, yet clinical recognition remains challenging. This article reports a 38-year-old female patient who underwent laparoscopic combined hysteroscopic tubal lavage under general anesthesia for “bilateral tubal obstruction.” During the procedure, the patient suddenly developed a heart rate of 40 beats per minute, followed by torsade de pointes (TdP) that rapidly progressed to cardiac arrest. The patient was successfully resuscitated after timely cardiopulmonary resuscitation, defibrillation, and pharmacological interventions. Postoperative electrocardiogram and 24-h Holter monitoring showed progressive prolongation of the QTc interval, reaching a maximum of 581 ms. Follow-up electrocardiogram at 1 month post-surgery showed that the QTc interval had returned to normal (421 ms). Based on a review of the literature, the final diagnosis was aLQTS. aLQTS is one of the important causes of perioperative cardiac arrest. Female sex, electrolyte disturbances, bradycardia, and QT-prolonging medications can act synergistically as triggers. Comprehensive interventions including early recognition of abnormal electrocardiographic signals, timely resuscitation, and correction of precipitating factors are key to improving prognosis.