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Torsade de pointes

Synonyms: torsade de pointes tachycardia
German: Torsade-de-Pointes-Tachykardie

1 Definition

Torsade de pointes is a ventricular tachycardia. It presents in the ECG as waves (chamber complexes) rotating along the isoelectric line with a frequency >150 min-1. The amplitudes change about every five to ten beats, which gives rise to their typical spindle-shaped look.

2 Pathogenisis

The torsade de points tachycardia can occur because of an extrasystole happening during the vulnerable phase of repolarisation. These extrasystoles can happen because of previous postdepolarisations. There are some factors which make this event more likely:

In the absence of the factors the torsade de pointes tachycardia is highly unlikely. As being apparent from the previous list, the QT interval elongation and changed membrane potential leading to prolonged and easier activation of the cells are essential.

3 Clinical presentation

The torsade de pointes tachycardia appears suddenly and normally terminates itself spontaneously. Typical symptomes include vertigo, syncopation and nausea. In bad cases the torsade de pointes can turn into ventricular fibrillations which can end deadly.

4 Treatment

In case the torsade de pointes persists, the acute treatment should be cardioversion. The administration of magnesium (bolus injection) and potassium up to borderline high values plays an important role in stabilizing the membrane potential.

Arrhythmia proving substances (if it is not a congenital Long-QT syndrome) need to be discontinued.

Implantation of a pacemaker should be considered if bradycardia is present. Possible treatments for the congenital form is a longterm prophylactic administration of beta blockers or the implantation of an ICD (implantable cardioverter defibrilliator).


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