What Is Torsades de Pointes?

Overview

Torsades de pointes (French for “twisting of

the points”) is one of several types of life-
threatening heart rhythm disturbances. In the
case of torsades de pointes (TdP), the heart’s
two lower chambers, called the ventricles,
beat faster than and out of sync with the
upper chambers, called the atria.

An abnormal heart rhythm is called

an arrhythmia. When the heart beats much
faster than normal, the condition is called
tachycardia. TdP is an unusual type of
tachycardia that sometimes resolves on its
own, but can also worsen into a serious heart
condition called ventricular fibrillation.
Ventricular fibrillation can lead to cardiac
arrest, an event in which the heart suddenly
stops. Cardiac arrest is usually fatal.

Symptoms and diagnosis

TdP can come on without warning. You may
suddenly feel your heart beating faster than
normal, even when you’re at rest. In some
TdP episodes, you may feel light-headed and
faint. In the most serious cases, TdP can
cause cardiac arrest or sudden cardiac death.

It’s also possible have an episode (or more

than one) that resolves quickly. This type
of ventricular tachycardia is known as
“unsustained.” “Sustained” ventricular
tachycardia interferes with the normal
functioning of the heart.

Torsades de pointes EKG

An electrocardiogram (EKG) measures your

heart’s electrical activity. Your heartbeat is
controlled by electrical signals that start at the
top of your heart and travel down to the
ventricles. Along the way, your heart contracts
and pumps blood out to the body.

An electrocardiograph tracks the electrical

signals all the way through this process and
then displays them as wavy lines on an EKG.
If you have TdP, the lines look like row after
row of twisted ribbon.

Causes

TdP can be a complication of a rare condition

known as long QT syndrome. Most people
with long QT syndrome are born with it,
though you can get it later in life.

Q and T are two of the five waves tracked in

an EKG. The electrical activity in the heart
that occurs between the Q and T waves is
called the QT interval. A QT interval is
measured from the start of the Q wave
through the end of the T wave. If this interval
is abnormally long, you are at a higher risk for
ventricular tachycardia and TdP.

In a 2013 studyTrusted Source, researchers

could find only 46 reported cases of TdP
between 1978 and 2011. In nearly all of these
cases, TdP coincided with a long QT interval.
These were perioperative TdP cases,
meaning they were present before someone
underwent heart surgery. In some cases,
heart surgery can lead to arrhythmias.
TdP episodes may be triggered by the use of
certain drugs. These drugs include certain
antibiotics and antipsychotics in addition to
other medications.

Tricyclic antidepressants may also put you at

greater risk of TdP. Certain antiarrhythmia
drugs, which are designed to restore a healthy
heart rhythm for people with arrhythmias, are
also associated with TdP. Some of the
antiarrhythmic drugs of concern are:

 quinidine
 procainamide
 disopyramide

You may also be at a higher risk for TdP if you

are low in potassium or magnesium or have
liver or kidney disease.

Women are at a higher risk than men of one

day having TdP.

Treatment

If you are diagnosed with TdP, your doctor will

check your potassium, magnesium, and
calcium levels. If they are low, you will be
given supplements to get your levels up into
the healthy range. You will also undergo EKG
monitoring until your heart returns to a normal
rhythm.

Your doctor may prescribe antiarrhythmic

drugs to help resolve your current TdP
episode and to prevent future events.

If your doctor determines that you are at high

risk for more TdP episodes, they may
recommend you have a pacemaker implanted
in your chest. This will help keep your heart
beating at a safe rhythm.

Another device that is sometimes part of a

pacemaker, called an implantable cardioverter
defibrillator (ICD), may also be helpful. An ICD
monitors your heart rate. When an abnormal
rhythm is detected, the device sends a small
electrical charge to the heart with the goal of
jolting it back into a normal rhythm.