Torsades de Pointes (Torsade de Pointes)

A malignant form of polymorphic ventricular tachycardia that is characterized by HEART RATE between 200 and 250 beats per minute, and QRS complexes with changing amplitude and twisting of the points. The term also describes the syndrome of tachycardia with prolonged ventricular repolarization, long QT intervals exceeding 500 milliseconds or BRADYCARDIA. Torsades de pointes may be self-limited or may progress to VENTRICULAR FIBRILLATION.

Also Known As:

Networked: 1655 relevant articles (42 outcomes, 90 trials/studies)

Relationship Network

Disease Context: Research Results

Related Diseases

1.	Ventricular Tachycardia
2.	Tachycardia (Tachyarrhythmias)
3.	Cardiac Arrhythmias (Arrythmia)
4.	Heart Failure
5.	Long QT Syndrome

Experts

1.	Hancox, Jules C: 17 articles (08/2015 - 01/2003)
2.	Vieweg, W Victor R: 14 articles (10/2014 - 01/2002)
3.	Sugiyama, Atsushi: 13 articles (07/2015 - 04/2002)
4.	Vos, Marc A: 13 articles (11/2013 - 08/2003)
5.	Belardinelli, Luiz: 13 articles (01/2013 - 08/2003)
6.	Hasnain, Mehrul: 12 articles (10/2014 - 01/2009)
7.	Khan, Ijaz A: 12 articles (03/2005 - 01/2002)
8.	Krantz, Mori J: 11 articles (09/2015 - 09/2002)
9.	Baranchuk, Adrian: 11 articles (06/2014 - 01/2010)
10.	Antzelevitch, Charles: 11 articles (08/2008 - 02/2003)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Torsades de Pointes:

1.	Magnesium Sulfate (Sulfate, Magnesium)FDA LinkGeneric 10/23/1997 - "Intravenous administration of high-dose magnesium sulfate has been demonstrated to be effective in terminating and preventing new episodes of torsades de pointes. " 02/01/1999 - "Clinical experience indicates that intravenous magnesium sulfate is effective in reversing torsades de pointes, but the molecular basis of this effect is not understood. " 12/01/1990 - "The effect of magnesium sulfate on ventricular refractoriness and its efficacy for torsade de pointes (TdP) were studied in nineteen dogs. " 12/01/1990 - "Effect of magnesium sulfate on ventricular refractoriness and its efficacy for torsade de pointes." 10/01/1986 - "Efficacy of magnesium sulfate in the treatment of torsade de pointes."
2.	MagnesiumIBA 03/01/2004 - "Correction of electrolyte disturbances has been long advised and magnesium supplementation has been beneficial in the treatment of torsades de pointes and in some studies after cardiac surgery. " 11/01/1999 - "It seems clear that intravenous magnesium also is effective for the suppression of ventricular ectopy in the hospital setting and is a first-line agent for torsades de pointes. " 05/01/2015 - "Forty-five percent and 36% believed magnesium could shorten QTc and prevent torsades de pointes, respectively. " 03/11/2013 - "During admission she developed torsades de pointes and was treated with magnesium sulphate and temporary pacing. " 07/01/2009 - "Only one case of torsade de pointes occurred in the no magnesium group during the index hospital admission. "
3.	Sotalol (Sotalol Hydrochloride)FDA LinkGeneric 12/01/1985 - "The differential effect of sotalol on isolated trabeculae and Purkinje strand preparations may help to explain the clinically reported phenomenon of sotalol-induced torsade de pointes." 04/01/2003 - "Torsades de pointes occurred in three out of 20 patients (15%) in the study population but in none of the control patients following i.v. sotalol testing. " 11/15/1996 - "The present study was undertaken to test the hypothesis that women are more prone than men to develop torsade de pointes (TdP) in a defined cohort of patients exposed to the QT-prolonging antiarrhythmic drug d,l-sotalol. " 09/01/2015 - "An ECG-based index quantifying restitution dispersion, DRest, is evaluated in patients who experienced Torsades de Pointes (TdP) under sotalol challenge and compared with the response in healthy subjects. " 01/01/2009 - "Sotalol induced QT prolongation and torsades de pointes."
4.	Bepridil (Vascor)FDA Link 08/01/2007 - "The addition of bepridil to class I AADs is effective and safe for AF, but careful observation using periodic ECG recordings is essential for avoiding torsades de pointes caused by QT prolongation." 04/09/1992 - "Several comparative clinical trials assessing the safety of bepridil have concluded that the drug may prolong the QT interval in certain patients; however, no occurrence of torsades de pointes was documented in these safety studies. " 06/01/2013 - "Bepridil is used as an antiarrhythmic drug due to its class I, class III, and class IV electrophysiological properties, but it has serious adverse effects such as QT prolongation and torsade de pointes. " 09/01/1994 - "The torsades de pointes with bepridil are serious side-effects, known right from 1982, and for which definite therapeutic recommendations were decreed in 1984 then in 1991. " 09/01/1994 - "[Bepridil and torsades de pointes: are the precautions of use respected?]."
5.	Verapamil (Calan)FDA LinkGeneric 07/01/2005 - "Verapamil prevents torsade de pointes by reduction of transmural dispersion of repolarization and suppression of early afterdepolarizations in an intact heart model of LQT3." 01/01/2004 - "A patient with LQTS in whom verapamil administration and permanent pacemaker implantation were useful for preventing torsade de pointes." 03/01/1999 - "Verapamil significantly shortened QT at low heart rates, mainly in the diurnal period, and this characteristic may explain, in part, the previously reported protective effect of verapamil against torsades de pointes." 11/01/1996 - "Anticholinergic overdose induced torsade de pointes successfully treated with verapamil." 05/01/1991 - "Suppression of Torsades de Pointes with verapamil in patients with atrio-ventricular block."
6.	Amiodarone (Amiodarona)FDA LinkGeneric 09/01/1993 - "The absence of amiodarone-induced reverse frequency-dependent effects on repolarization, together with its time-dependent effects on refractoriness may account in part for the high efficacy of the drug and its low propensity to cause torsade de pointes." 10/01/1989 - "The safety and efficacy of long-term amiodarone therapy were examined in 12 patients who had previously developed torsade de pointes as a complication of previous antiarrhythmic therapy. " 07/01/2006 - "Clinical study of amiodarone-associated torsade de pointes in Chinese people." 01/01/2014 - "Although amiodarone appears to have few pro-arrhythmic effects, torsade de pointes (TdP) has been observed after administration of a low dose and short term use of oral amiodarone, in the absence of predisposing factors. " 09/01/2012 - "We report a case of macroscopic T-wave alternans occurring 30 min before the onset of amiodarone-induced torsade de pointes, illustrating a means to monitor for proarrhythmia."
7.	Quinidine (Chinidin)FDA LinkGeneric 03/20/1987 - "Hypomagnesemia, especially in the presence of other electrolyte abnormalities, also affects automaticity and is associated with decreased efficacy of digitalis and with quinidine-related Torsades de pointes. " 12/01/1988 - "Our purpose in this study was to determine the circumstances under which quinidine might elicit torsades de pointes consistently in the intact dog. " 12/01/1987 - "The possibility that an asynchronous increase in the ventricular monophasic action potential duration is the basis of the quinidine-induced torsade de pointes, has led us to study the electrophysiological effects of increasing doses of intravenous quinidine. " 12/15/2015 - "Quinidine can cause QT prolongation, and women have longer QT intervals and are more susceptible to torsades de pointes (TdP) than are men. " 07/01/2015 - "Investigation of potential mechanisms of sex differences in quinidine-induced torsade de pointes risk."
8.	arsenic trioxide (Trisenox)FDA Link 10/01/2003 - "One hypokalemic, arsenic trioxide-treated patient with relapsed APL developed asymptomatic torsade de pointes, which resolved spontaneously and did not recur after electrolyte replacement. " 08/01/2004 - "Arsenic trioxide induces remission in many, but treatment can be complicated by QT prolongation, torsades de pointes and sudden death. " 05/01/2006 - "We describe 2 patients with acute promyelocytic leukemia (APL) in whom torsade de pointes (TdP) developed during treatment with arsenic trioxide. " 05/01/2006 - "Two cases of acute promyelocytic leukemia complicated by torsade de pointes during arsenic trioxide therapy." 03/01/2001 - "Torsades de pointes in 3 patients with leukemia treated with arsenic trioxide."
9.	ibutilide (Corvert)FDA LinkGeneric 06/01/2004 - "Purpose of this study was to determine whether women are more prone to develop ibutilide-induced torsade de pointes. " 09/01/2010 - "The most serious complication of ibutilide is torsades de pointes (TdP). " 04/01/2006 - "In three episodes torsade de pointes occurred after ibutilide (6.1%), requiring defibrillation in two cases (4.1%). " 10/12/2004 - "Ibutilide (Corvert): suspected association with torsades de pointes." 06/01/2004 - "Incidence of ibutilide-induced torsade de pointes is higher in women than in men. "
10.	Haloperidol (Haldol)FDA LinkGeneric 01/15/1998 - "The likelihood of torsades de pointes associated with intravenous haloperidol is significantly greater in patients receiving > or = 35 mg over 24 hours or in those with a QTc interval of >500 ms, or both." 06/01/2001 - "Although intravenous haloperidol (HAL) is an effective medication that is often prescribed to treat agitation, several instances of torsade de pointes or prolonged QT interval have been reported. " 05/01/2004 - "Mechanisms by which haloperidol causes torsades de pointes have not been widely investigated in controlled studies. " 11/01/2012 - "Clinicians have been challenged to consider alternative agents due to adverse effects such as extrapyramidal symptoms, QTc prolongation, and possible torsades de pointes with haloperidol use. " 04/01/2010 - "In September 2007, the Food and Drug Administration (FDA) strengthened label warnings for intravenous (IV) haloperidol regarding QT prolongation (QTP) and torsades de pointes (TdP) in response to adverse event reports. "

Therapies and Procedures

1.	Electric Countershock (Cardioversion) 05/01/2004 - "Despite supportive care, he developed typical, sustained, torsades de pointes with a markedly prolonged QT interval requiring cardioversion. " 03/01/2004 - "Torsade de pointes was terminated with direct current cardioversion. " 11/01/2003 - "Torsades de pointes following cardioversion: case history and literature review." 01/01/2002 - "Two female patients (6.9%) developed torsade de pointes, requiring direct current cardioversion under general anaesthesia. " 07/01/1997 - "Six minutes after drug administration the QT prolonged to 600 msec, and the patient developed torsades de pointes and required electrical cardioversion. "
2.	Anesthesia 04/26/2013 - "The available data regarding prevention of lethal Torsades de Pointes during anesthesia in patients with long QT syndrome is scant and conflicting: only case reports and small case series with different outcomes have been published. " 01/01/2011 - "Eight minutes following uneventful induction of anesthesia 'torsade de pointes' occurred, terminated by a counter shock. " 01/01/2011 - "The amount of literature available on Torsades de pointes occurring in patients with pheochromocytoma is limited, and we found no literature describing this dysrhythmia in a patient with pheochromocytoma under anesthesia. " 09/01/1995 - "After induction of anesthesia, his electrocardiogram displayed a frequent torsade de pointes type of ventricular tachycardia with prolonged QT interval. " 09/01/2011 - "Just after induction of anesthesia, sinus bradycardia occurred, and 9 minutes after tracheal intubation, ECG suddenly showed torsade de pointes (TdP) and the arterial blood pressure decreased leading to asystole. "
3.	Defibrillators (Defibrillator) 04/01/2014 - "Pacing-induced torsades de pointes after the short-long-short sequence in a patient with a biventricular defibrillator: what is the mechanism?" 05/01/1993 - "Left sympathetic denervation or implantation of an automatic defibrillator are exceptional therapeutic options in refractory congenital torsades de pointes." 07/01/2015 - "Inconsistent shock advisories for monomorphic VT and Torsade de Pointes--A prospective experimental study on AEDs and defibrillators." 01/01/1994 - "Torsades de pointes and aborted sudden death after implantation of a cardioverter defibrillator." 06/01/2001 - "When the true cause emerged during a monitored episode of torsades de pointes, electric defibrillation was used to restore sinus rhythm and isoproterenol administered to increase heart rate and thus shorten the prolonged QT interval Long-term control was obtained by means of an implantable intracardiac defibrillator. "
4.	Intravenous Injections 09/22/1990 - "Torsade de pointes disappeared after a single intravenous injection of 2 g magnesium sulfate. " 01/01/1988 - "[Attack of torsades de pointes induced by an intravenous injection of erythromycin lactobionate]." 06/01/1986 - "She developed recurrent syncopal torsades de pointes during the 24th hour which were reduced by a bolus intravenous injection of 3 g of magnesium sulphate (Mg SO4). " 03/01/1986 - "In 6 cases of torsades de pointes, magnesium sulphate was administered at a dose 1 to 3 g by direct intravenous injection. " 02/01/1988 - "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. "
5.	Palliative Care (Palliative Medicine) 01/01/2010 - "Recent reports suggest that high doses of methadone may prolong QTc interval and occasionally cause torsades de pointes; however, few of these studies involved the palliative care population. " 12/01/2009 - "To examine the recent literature with regards to methadone, prolongation of the QT interval, torsade de pointes and the implications for palliative care clinicians. "