Torsades de pointes is a polymorphic ventricular tachy- cardia that can quickly evolve into ventricular fibrillation and sudden death. This arrhythmia often occurs second- ary to medication- induced cardiac repolarization dys- function with resultant prolonged QTc interval on ECG. Numerous medications can predispose patients to this deadly tachycardia. We report a case of methadone-in- duced Torsades de pointes complicated by ventricular fibrillation and cardiac arrest. Through rapid taper of methadone, the patient's ECG normalized, allowing for safe discharge. This clinical vignette highlights the im- portance of close monitoring of patient medications. Per- forming periodic ECGs with prompt removal of offending agent when repolarization abnormalities are appreciated is ideal. Most importantly, as the vast array of medica- tions continues to grow, it is imperative that clinicians are cognizant of side effects and tailor treatment accordingly.
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