{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T05:01:09Z","timestamp":1790830869053,"version":"4.1.0"},"reference-count":6,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Clinical Apheresis"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Citrate anticoagulation during therapeutic plasma exchange (TPE) chelates divalent cations and can precipitate torsades de pointes (TdP) in patients with pre\u2010existing repolarization vulnerability. We report a 44\u2010year\u2010old woman with genetically determined long QT syndrome Type 2 (LQT2) presenting in myasthenic crisis due to anti\u2010MuSK\u2010positive myasthenia gravis. TPE was initiated urgently before confirmatory antibody results were available, as alternative rapid immunomodulatory options were not immediately accessible. Despite prophylactic electrolyte supplementation, the corrected QT interval (QTc) progressively prolonged, rising from a baseline of 493 to 509\u2009ms\u2014exceeding the 500\u2009ms high\u2010risk threshold\u2014immediately before TdP onset during the second TPE. TPE was discontinued and replaced with double\u2010filtration plasmapheresis (DFPP) using albumin\u2010based replacement, which reduces citrate exposure by retaining the patient's own albumin. Five subsequent DFPP sessions were completed without arrhythmia recurrence. This case highlights the apheresis\u2010related arrhythmia risk in LQT2 and the mechanistic rationale for DFPP as a safer alternative.<\/jats:p>","DOI":"10.1002\/jca.70185","type":"journal-article","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T04:41:29Z","timestamp":1790829689000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Apheresis\u2010Triggered Torsades De Pointes in Congenital Long\n                    <scp>QT<\/scp>\n                    Syndrome Type 2: Citrate\u2010Related Arrhythmia Risk and Safe Modality Switching During Myasthenic Crisis"],"prefix":"10.1002","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7257-0796","authenticated-orcid":false,"given":"Masahiro","family":"Biyajima","sequence":"first","affiliation":[{"name":"Department of Neurology Japanese Red Cross Nagano Hospital  Nagano Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusuke","family":"Nakamura","sequence":"additional","affiliation":[{"name":"Department of Neurology Japanese Red Cross Nagano Hospital  Nagano Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshihiro","family":"Nagaoka","sequence":"additional","affiliation":[{"name":"Department of Nephrology Japanese Red Cross Nagano Hospital  Nagano Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ko\u2010Ichi","family":"Tazawa","sequence":"additional","affiliation":[{"name":"Department of Neurology Japanese Red Cross Nagano Hospital  Nagano Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"issue":"9","key":"e_1_2_9_2_1","doi-asserted-by":"crossref","first-page":"934","DOI":"10.1016\/j.jacc.2010.01.001","article-title":"Prevention of Torsade de Pointes in Hospital Settings: A Scientific Statement From the American Heart Association and the American College of Cardiology Foundation","volume":"55","author":"Drew B. J.","year":"2010","journal-title":"Journal of the American College of Cardiology"},{"issue":"8","key":"e_1_2_9_3_1","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1007\/s005350170061","article-title":"Alcoholic Liver Cirrhosis Complicated With Torsade de Pointes During Plasma Exchange and Hemodiafiltration","volume":"36","author":"Nakasone H.","year":"2001","journal-title":"Journal of Gastroenterology"},{"issue":"2","key":"e_1_2_9_4_1","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1002\/jca.22043","article-title":"Guidelines on the Use of Therapeutic Apheresis in Clinical Practice\u2014Evidence\u2010Based Approach From the Writing Committee of the American Society for Apheresis: The Ninth Special Issue","volume":"38","author":"Connelly\u2010Smith L.","year":"2023","journal-title":"Journal of Clinical Apheresis"},{"issue":"1","key":"e_1_2_9_5_1","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1016\/j.jns.2007.05.033","article-title":"MuSK Antibody Clearance During Serial Sessions of Plasmapheresis for Myasthenia Gravis","volume":"263","author":"Yeh J. H.","year":"2007","journal-title":"Journal of the Neurological Sciences"},{"issue":"1","key":"e_1_2_9_6_1","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1002\/mus.22006","article-title":"Anti\u2010MuSK Antibody Myasthenia Gravis: Clinical Findings and Response to Treatment in Two Large Cohorts","volume":"44","author":"Guptill J. T.","year":"2011","journal-title":"Muscle and Nerve"},{"issue":"7","key":"e_1_2_9_7_1","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1016\/S1474-4422(21)00159-9","article-title":"Safety, Efficacy, and Tolerability of Efgartigimod in Patients With Generalised Myasthenia Gravis (ADAPT): A Multicentre, Randomised, Placebo\u2010Controlled, Phase 3 Trial","volume":"20","author":"Bril V.","year":"2021","journal-title":"Lancet Neurology"}],"container-title":["Journal of Clinical Apheresis"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jca.70185","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jca.70185","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jca.70185","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T04:41:42Z","timestamp":1790829702000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jca.70185"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,30]]},"references-count":6,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1002\/jca.70185"],"URL":"https:\/\/doi.org\/10.1002\/jca.70185","archive":["Portico"],"relation":{},"ISSN":["0733-2459","1098-1101"],"issn-type":[{"value":"0733-2459","type":"print"},{"value":"1098-1101","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,30]]},"assertion":[{"value":"2026-04-13","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-22","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-30","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70185"}}