: The most common cause of acquired long QT syndrome in patients without physiological and structural cardiovascular disease is the use of medications. Chronic high-dose methadone usage can cause prolongation of QT interval that may provoke the life-threatening arrhythmia Torsades de Pointes. In this study, we present a 41-year-old man with chronic high-dose methadone usage who developed Torsades de Pointes triggered by short-coupled premature ventricular contraction.