Torsade de pointes in a patient with complete atrioventricular block and pacemaker failure, misdiagnosed with epilepsy

• We report a complete atrioventricular block case with pacemaker manifested recurrent seizure-like episodes and misdiagnosed with epilepsy.
• An episode of seizure-like attack was confirmed by Holter recording showing run of torsade de pointes.
• Patients with heart block after pacemaker implantation developed torsade de pointes due to intermittent pacing failure and severe hypokalemia has been seldom reported.

A case of torsade de pointes (TdP) with complete atrioventricular block and pacemaker failure that was misdiagnosed as epilepsy is presented herein. An 82-year-old female with recurrent seizure-like attacks showed epileptiform discharge during an electroencephalogram recording. A long QT interval and severe hypokalemia induced runs of TdP, which was related to pacemaker lead fracture, was detected during Holter recording and accompanied with episodes of seizures. After a DDD pacemaker with a new ventricular lead was replaced, there was no recurrence of any seizure-like attacks. Bradycardia-mediated TdP associated with complete atrioventricular block should not be missed in patients with recurrent seizure-like attacks even after pacemaker implantation.