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.