Clinical Study on Torsades de Pointes

Torsades de pointes is characterized by paroxysms of ventricular tachycardia at rates typically greater than 200 beats/min in which QRS morphology shows alternating polarity in an undulating pattern so that the complexes appear to be twisting about the beseline;this arrhythmia is virtually always associated with prolongation of the QT interval. Its importance lies not in its unusual structure but in the potentially fatal outcome if conventional treatment is administred.

Torsades de pointes was diagnosed in 4 patients;the first with hypokalemia, the second with congenital QT prolongation syndrome, the third with amiodarone, the fourth with organophosphorous and hypokalemia. Treatment of these patients consisted of potassium supply, isoproterenol, lidocaine, phenobarbital, tenormin, phenytoin, cardioversion, atropine. Three patients improved successfully, but one patient died, as a direct result of the ensuing ventricular fibrillation and cardiac arrest on one hour after admission.