Ibn Sina Journal of Medical Science, Health & Pharmacy

Abstract

ABSTRACT
Long QT Syndrome (LQTS) is a cardiac channelopathy characterized by delayed myocardial repolarization, predisposing patients to torsades de Pointes (TdP), ventricular fibrillation (VF), and sudden cardiac death, and it is frequently misdiagnosed as a neurological disorder due to seizure-like presentations. The objective of this case study is to illustrate the diagnostic challenges in differentiating cardiac arrhythmias from neurological events and to emphasize the importance of early electrocardiographic (ECG) evaluation in patients with unexplained syncope or convulsive episodes. A detailed clinical review was conducted of a 30-year-old woman admitted for an ulcerative colitis flare who developed recurrent seizure-like episodes during hospitalization. Diagnostic evaluation included serial ECGs, telemetry monitoring, neurological assessment, laboratory investigations, and review of QT-prolonging medications. Despite correction of metabolic abnormalities and adjustment of antiepileptic and psychotropic medications, her episodes persisted. A prolonged QTc interval was identified, and the patient subsequently experienced VF requiring resuscitation. Telemetry confirmed TdP, and retrospective history revealed prior stress-related syncopal episodes, suggesting a congenital predisposition. Management involved electrolyte optimization, beta-blocker therapy, magnesium and lidocaine administration, and implantation of a dual-chamber cardioverter-defibrillator (ICD) for secondary prevention. The patient demonstrated clinical stability on follow-up with no recurrent arrhythmias or device shocks. This case highlights the need for heightened clinical suspicion for LQTS in seizure-like presentations that lack typical postictal features and do not respond to neurological treatment. It underscores the value of early ECG screening, comprehensive history-taking, and multidisciplinary management, as timely recognition and appropriate therapy are essential to preventing life-threatening arrhythmias and improving long-term outcomes.

Keywords: Long QT Syndrome; Ventricular Fibrillation; Syncope;
Seizure-like Episodes.

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Article history_en

Received : Nov 01, 2025

Revised : Nov 02, 2025

Accepted : Nov 29, 2025

Authors Affiliations_en

Mohamed Alawlaqi*, Noura AlDosari, Sarah Al Qassimi

Ethics declarations_en

Acknowledgment	Acknowledgment: The authors would like to thank the patient and her family for their cooperation and consent in sharing this case. We also acknowledge the contributions of the multidisciplinary team involved in the patient’s care, including the departments of cardiology, neurology, psychiatry, and intensive care, whose expertise was essential in the management of this case.
Author Contribution	All authors contributed equally to the main contributor to this paper. All authors read and approved the final paper.
Conflicts of Interest	“The authors declare no conflict of interest.”
Funding	“This research received no external funding”