Torsades de pointes during ibutilide administration in a patient on long-term osimertinib after pulsed field ablation: a case report

Abstract Osimertinib, a third-generation EGFR-TKI, is the standard of care in first-line therapy for advanced EGFR-mutant non-small cell lung cancer (NSCLC), but with the potential proarrhythmic effects including QT prolongation and atrial fibrillation (AF). We report a 77-year-old woman on long-term osimertinib for non-small cell lung cancer who developed early recurrent AF on postoperative day 1 following pulsed field ablation (PFA). Intravenous ibutilide was administered for cardioversion, during which she developed torsades de pointes (TdP) with transient loss of consciousness that resolved spontaneously after drug discontinuation and electrolyte supplementation. This case highlights the proarrhythmic risk when ibutilide is used in patients receiving osimertinib, particularly in the setting of recent ablation and early post-procedural rhythm instability. Caution is warranted with QT-prolonging agents in this population, and close ECG monitoring is essential.