WARREN M. SMITH, M.D.; JOHN J. GALLAGHER, M.D.
Grant support: in part by Grants RR-30 from the General Clinical Research Centers Branch, Division of Health Resources, and HL 15190 from the National Institutes of Health, Bethesda, Maryland. This work was done during Dr. Gallagher's tenure as an Established Investigator of the American Heart Association.
▸Requests for reprints should be addressed to Warren M. Smith, M.D.; Box 3432, Division of Cardiology, Duke University Medical Center; Durham, NC 27710.
SMITH WM, GALLAGHER JJ. "Les Torsades de Pointes": An Unusual Ventricular Arrhythmia. Ann Intern Med. 1980;93:578-584. doi: 10.7326/0003-4819-93-4-578
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Published: Ann Intern Med. 1980;93(4):578-584.
Since the original description by Dessertenne, predominantly European literature has reported the features of the unusual ventricular arrhythmia "les torsades de pointes." Named because of the way the polarity of the QRS complexes seems to spiral around the baseline of the ECG, this arrhythmia is virtually always associated with prolongation of the Q-T interval. Its importance lies not in its unusual structure but in the potentially fatal outcome if conventional treatment is administered. Antiarrhythmic drugs that further prolong the Q-T interval frequently aggravate the arrhythmia and are contraindicated. Overdrive pacing, preferably atrial, is the treatment of choice with attention to any correctable causes of associated Q-T prolongation. Electrophysiologic studies so far favor a re-entrant cause for the arrhythmia, but the exact mechanism and its true relation to both conventional ventricular tachycardia and ventricular fibrillation remain to be defined.
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