Circulation, Vol 64, 1167-1174, Copyright © 1981 by American Heart Association
A Keren, D Tzivoni, D Gavish, J Levi, S Gottlieb, J Benhorin and S Stern
Torsade de pointes, also called atypical ventricular tachycardia (AVT), was
diagnosed in 10 patients, nine on antiarrhythmic therapy and one with acute
central nervous system damage. Four patients received quinidine and five
disopyramide, either alone or in combination with amiodarone. AVT was
dose-dependent in some, but in others, it started shortly after initiation
of drug therapy (idiosyncrasy). All patients had QT prolongation longer
than 0.60 second immediately before the onset of AVT. This measurement
appeared to be a more sensitive predictor of the development of AVT than
QTc prolongation or QRS widening. All patients also showed bradycardia
before AVT onset. After therapy, the QT immediately decreased, while QTc
and QRS remained prolonged for longer periods. Isoproterenol was effective
in five of seven patients, but was contraindicated in two others.
Ventricular pacing was used in four patients, including the two who did not
respond to isoproterenol, and this abolished AVT promptly. Isoproterenol or
pacing appear to be the therapy of choice for AVT, while the conventional
drugs used to treat the usual form of ventricular tachycardia are not only
ineffective, but even contraindicated.
ARTICLES
Etiology, warning signs and therapy of torsade de pointes. A study of 10 patients
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