Torsade de Pointes

This is part of: Ventricular Arrhythmias

Torsade de Pointes (TdP)
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Atrial rate	60-100 bpm
Ventricular rate	150-300 bpm
Regularity	regular
Origin	ventricles
P-wave	AV-dissociation
Effect of adenosine	no rate reduction (sometimes accelerates)
Example ECG: Initiation of Torsade de Pointes (TdP) by a short-long-short sequence
Example ECG2: {{{example2}}}

Torsade de pointes is a ventricular tachycardia associated with a long QT time on the resting ECG. Torsade de pointes is typically initiated by a short-long-short interval. A ventricle extrasystole (first beat: short) is followed by a compensatory pause. The following beat (second beat: long) has a longer QT interval. If the next beat follows shortly thereafter, ther is a good chance that this third beat falls within the QT interval, resulting in the R on T phenomenon and subsequent Torsades de pointes. During Torsades de pointes the ventricles depolarize in a circular fashion resulting in QRS complexes with a continuously turning heart axis around the baseline (hence the name Torsade de Pointes). Read the chapter on the Long QT Syndrome for an list of causes.

There has been much debate in the Circulation journal among French and American scientist whether one should write Torsades de Pointes or Torsade de Pointes. As for now Torsade is prefered (unless one sees rotations around more than one axis in one episode), but both forms are used in similar frequency.[1]

Examples

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  A twelve lead registration of Torsade de pointes. Reprinted with permission Copyright 2001 Texas Heart Institute [2]

References

1. Moise NS. As Americans, we should get this right. Circulation. 1999 Sep 28;100(13):1462. DOI:10.1161/01.cir.100.13.1462 |
2. Khan IA. Twelve-lead electrocardiogram of torsades de pointes. Tex Heart Inst J. 2001;28(1):69.