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ȣ - 520840 63 |
| Torsade de pointes: precipitating factors, clinical features, and management. |
| 경북대학교병원 순환기내과¹, 계명대학교 동산의료원 심장내과², 영남대학교병원 순환기내과³, 대구파티마 병원⁴ |
| 이장훈, 조용근¹ , 류현민¹, 배명환¹, 권용섭¹, 양동헌¹, 박헌식¹, 채성철¹, 전재은¹, 박의현¹, 김윤년², 조윤경², 신동구³, 정병천⁴ |
BACKGROUND AND OBJECTIVES: Torsade de pointes (TdP) is rare, but life-threatening arrhythmia. Limited data are available for the clinical characteristics in patients with the TdP. We investigated precipitating factors, clinical features, and management of the TdP in Korea. METHODS: Fourteen patients (13 females; mean age, 59±23 years old, ranged from 22 to 91 years old) with TdP included in this multicenter, retrospective study. Mean follow-up duration was 35 months. RESULTS: Of 14 patients, 11 (78%) had an underlying heart disease. The precipitating factors involved in the appearance of the TdP were complete atrioventricular (AV) block (35%), long QT syndrome (21%). hypokalemia (14%), sinus bradycardia (14%), premature ventricular complex (7%), and operation (7%). Most common ECG finding initiating the TdP was prolonged QT interval (85%) followed by T wave inversion (42%). Short-long-short sequence initiating the TdP was observed in 6 (42%) patients. In patients with complete AV block, the QT interval was markedly prolonged (mean QTc=565.8±79.1ms, ranged from 448 to 662ms) and ventricular rate was markedly slow (39±6 beats/min). The withdrawal and correction of a treatable cause was sufficient for the initial therapy of the TdP in only 1 patient while intravenous magnesium sulfate (20%), beta-blockers (35%), isoproterenol (14%) were needed in most patients. Permanent pacemaker implantation was performed in 6 (42%) patients including 4 patients with complete AV block and 2 patients with sick sinus syndrome. ICD implantation was performed in 1 (7%) patient with long QT syndrome. Beta-blockers were used in 7 (50%) patients as a long-term medical therapy. Two patients discharged and followed up with no therapy. During the follow-up periods, recurrence of TdP or sudden cardiac death was not observed in all cases. CONCLUSIONS: There was a marked female predominance in the occurrence of TdP. Most predisposed patients were old and had an underlying heart disease including complete AV block and long QT syndrome. Long-term pharmacological and non-pharmacological therapies were required and useful for the prevention of recurrence of TdP.
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