Circulation, Vol 77, 392-397, Copyright © 1988 by American Heart Association
D Tzivoni, S Banai, C Schuger, J Benhorin, A Keren, S Gottlieb and S Stern
Twelve consecutive patients who developed torsade de pointes (polymorphous
ventricular tachycardia with marked QT prolongation, TdP) over a 4 year
period were treated with intravenous injections of magnesium sulfate. In
nine of the patients a single bolus of 2 g completely abolished the TdP
within 1 to 5 min, and in three others complete abolition of the TdP was
achieved after a second bolus was given 5 to 15 min later. Nine of the
patients also received continuous infusion of MgSO4 (3 to 20 mg/min) for 7
to 48 hr until the QT interval was below 0.50 sec. In nine of the 12
patients the TdP was induced by antiarrhythmic agents. The QT interval
preceding TdP ranged from 0.54 to 0.72 sec. After the MgSO4 bolus, which
prevented the recurrence of TdP, no significant changes were observed in
the QT interval. There were no side effects of this treatment. In eight of
the 12 patients potassium levels before the TdP were below 3.5 meq/liter;
magnesium levels were available in eight patients before TdP, and were
normal in all. Five additional patients with polymorphous ventricular
tachycardia but normal QT intervals (non-TdP patients) received two to
three boluses of MgSO4. This treatment was ineffective in all, but they
responded to conventional antiarrhythmic therapy. Thus, MgSO4 is a very
effective and safe treatment for TdP, and its application is rapid and
simple. Its use is therefore recommended as the first line of therapy for
TdP.
ARTICLES
Treatment of torsade de pointes with magnesium sulfate
Heiden Department of Cardiology, Bikur Cholim Hospital, Jerusalem, Israel.
This article has been cited by other articles:
 |
|
 |
|
  J. Stringer, C. Welsh, and A. Tommasello Methadone-associated Q-T interval prolongation and torsades de pointes Am. J. Health Syst. Pharm., May 1, 2009; 66(9): 825 - 833. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. D. Hunter, P. Sharma, and S. Rathi Long QT syndrome CEACCP, April 1, 2008; 8(2): 67 - 70. [Full Text] [PDF]
|
|
|
|
 |
|
 B. Ali and A. M. Zafari Narrative Review: Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: Review of the Current Guidelines Ann Intern Med, August 7, 2007; 147(3): 171 - 179. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Reising, F. Kusumoto, and N. Goldschlager Life-Threatening Arrhythmias in the Intensive Care Unit J Intensive Care Med, January 1, 2007; 22(1): 3 - 13. [Abstract] [PDF]
|
|
|
|
 |
|
 Developed in Collaboration With the European Heart, D. P. Zipes, A. J. Camm, M. Borggrefe, A. E. Buxton, B. Chaitman, M. Fromer, G. Gregoratos, G. Klein, A. J. Moss, et al. ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death--Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) J. Am. Coll. Cardiol., September 5, 2006; 48(5): 1064 - 1108. [Full Text] [PDF]
|
|
|
|
|
|
Developed in Collaboration With the European Heart, D. P. Zipes, A. J. Camm, M. Borggrefe, A. E. Buxton, B. Chaitman, M. Fromer, G. Gregoratos, G. Klein, A. J. Moss, et al. ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) J. Am. Coll. Cardiol., September 5, 2006; 48(5): e247 - e346. [Full Text] [PDF]
|
|
|
|
 |
|
 D. P. Zipes, D. P. Zipes, A. J. Camm, M. Borggrefe, A. E. Buxton, B. Chaitman, M. Fromer, G. Gregoratos, G. Klein, A. J. Moss, et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death--executive summary: A report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Eur. Heart J., September 1, 2006; 27(17): 2099 - 2140. [Full Text] [PDF]
|
|
|
|
 |
|
 Writing Committee Members, D. P. Zipes, A. J. Camm, M. Borggrefe, A. E. Buxton, B. Chaitman, M. Fromer, G. Gregoratos, G. Klein, A. J. Moss, et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: A report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society Europace, September 1, 2006; 8(9): 746 - 837. [Full Text] [PDF]
|
|
|
|
 |
|
 Part 7.2: Management of Cardiac Arrest Circulation, December 13, 2005; 112(24_suppl): IV-58 - IV-66. [Full Text] [PDF]
|
|
|
|
|
|
Part 7.3: Management of Symptomatic Bradycardia and Tachycardia Circulation, December 13, 2005; 112(24_suppl): IV-67 - IV-77. [Full Text] [PDF]
|
|
|
|
|
|
Part 4: Advanced Life Support Circulation, November 29, 2005; 112(22_suppl): III-25 - III-54. [Full Text] [PDF]
|
|
|
|
|
|
L.J. Jordaens and J.M. Mekel Electrical storm in the ICD era Europace, January 1, 2005; 7(2): 181 - 183. [Full Text] [PDF]
|
|
|
|
 |
|
 K. Hoshino, K. Ogawa, T. Hishitani, T. Isobe, and Y. Eto Optimal Administration Dosage of Magnesium Sulfate for Torsades de Pointes in Children with Long QT Syndrome J. Am. Coll. Nutr., October 1, 2004; 23(5): 497S - 500S. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. M. van den Bergh, A. Algra, and G. J.E. Rinkel Electrocardiographic Abnormalities and Serum Magnesium in Patients With Subarachnoid Hemorrhage Stroke, March 1, 2004; 35(3): 644 - 648. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. D. Booker, S. D. Whyte, and E. J. Ladusans Long QT syndrome and anaesthesia Br. J. Anaesth., March 1, 2003; 90(3): 349 - 366. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P T Munro and C A Graham Torsade de pointes Emerg. Med. J., September 1, 2002; 19(5): 485 - 486. [Abstract] [Full Text]
|
|
|
|
|
|
P Kaye and I O'Sullivan The role of magnesium in the emergency department Emerg. Med. J., July 1, 2002; 19(4): 288 - 291. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Matsusaka, N. Hasebe, Y.-T. Jin, J. Kawabe, and K. Kikuchi Magnesium reduces myocardial infarct size via enhancement of adenosine mechanism in rabbits Cardiovasc Res, June 1, 2002; 54(3): 568 - 575. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Unnikrishnan, J. P. Dutcher, N. Varshneya, R. Lucariello, M. Api, S. Garl, P. H. Wiernik, and S. Chiaramida Torsades de pointes in 3 patients with leukemia treated with arsenic trioxide Blood, March 1, 2001; 97(5): 1514 - 1516. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. T. Speakman and E. Ostrzega Primary Hyperparathyroidism and Polymorphic Ventricular Tachycardia Journal of Cardiovascular Pharmacology and Therapeutics, January 1, 1999; 4(4): 269 - 271. [Abstract] [PDF]
|
|
|
|
 |
|
 D A Chamberlain Antiarrhythmic drugs in resuscitation Heart, October 1, 1998; 80(4): 408 - 411. [Full Text]
|
|
|
|
 |
|
 K. Katapadi, G. Kostandy, M. Katapadi, K.M.A. Hussain, D. Schifter, and G. Kostandy A Review of Erythromycin-Induced Malignant Tachyarrhythmia-- Torsade de Pointes: A Case Report Angiology, September 1, 1997; 48(9): 821 - 826. [Abstract] [PDF]
|
|
|
|
|
|
G. Stark, I. Schwarzl, U. Heiden, U. Stark, and H. A Tritthart Magnesium abolishes inadequate kinetics of frequency adaptation of the Q-aT interval in the presence of sotalol Cardiovasc Res, July 1, 1997; 35(1): 43 - 51. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Takanaka, K. O. Ogunyankin, J.S.M. Sarma, and B. N. Singh Antiarrhythmic and Arrhythmogenic Actions of Varying Levels of Extracellular Magnesium: Possible Cellular Basis for the Differences in the Efficacy of Magnesium and Lidocaine in Torsade de Pointes Journal of Cardiovascular Pharmacology and Therapeutics, January 1, 1997; 2(2): 125 - 134. [Abstract] [PDF]
|
|
|
|
|
|
M. C.P. Haigney, B. Silver, E. Tanglao, H. S. Silverman, J. D. Hill, E. Shapiro, G. Gerstenblith, and S. P. Schulman Noninvasive Measurement of Tissue Magnesium and Correlation With Cardiac Levels Circulation, October 15, 1995; 92(8): 2190 - 2197. [Abstract] [Full Text]
|
|
|
|
 |
|
 R. R. Makkar, B. S. Fromm, R. T. Steinman, M. D. Meissner, and M. H. Lehmann Female Gender as a Risk Factor for Torsades de Pointes Associated With Cardiovascular Drugs JAMA, December 1, 1993; 270(21): 2590 - 2597. [Abstract] [PDF]
|
|
|
|
|
|
Adult Advanced Cardiac Life Support JAMA, October 28, 1992; 268(16): 2199 - 2241. [Abstract] [PDF]
|
|
|
|
|
|
M. Akhtar, H. Garan, M. H. Lehmann, and P. J. Troup Sudden Cardiac Death: Management of High-Risk Patients Ann Intern Med, March 15, 1991; 114(6): 499 - 512. [Abstract] [PDF]
|
|
|
|
 |
|
 MAGNESIUM SULFATE EFFECTIVELY TREATS TORSADE DE POINTES Journal Watch (General), February 26, 1988; 1988(226): 2 - 2. [Full Text]
|
|