Dofetilide-induced torsade de pointes in high-grade atrioventricular node dysfunction

[...]the package insert for Biocor Epic tricuspid prosthesis specifically advises against this practice. 1-3 Instead, our patient underwent a subxiphoid surgical approach to place an epicardial right ventricular pacing lead. Since the TdP was precipitated by bradycardia and dofetilide (proarrhythmic agent) in the setting of AV dysfunction and loss of pacemaker capture, removing the offending agent (dofetilide) and addressing the lead dysfunction were sufficient to avoid further episodes of TdP. Dofetilide is known to prolong QT interval causing TdP.