TY - JOUR
T1 - Prevention of Torsade de Pointes in Hospital Settings. A Scientific Statement From the American Heart Association and the American College of Cardiology Foundation Endorsed by the American Association of Critical-Care Nurses and the International Society for Computerized Electrocardiology
AU - Drew, Barbara J.
AU - Ackerman, Michael J.
AU - Funk, Marjorie
AU - Gibler, W. Brian
AU - Kligfield, Paul
AU - Menon, Venu
AU - Philippides, George J.
AU - Roden, Dan M.
AU - Zareba, Wojciech
PY - 2010/3/2
Y1 - 2010/3/2
N2 - TdP is an uncommon but potentially fatal arrhythmia that can be caused by drugs that cause selective prolongation of action potential durations in certain layers of the ventricular myocardium, which creates dispersion of repolarization and a long, distorted QT-U interval on the ECG. A summary of key points to remember is provided in Table 3. For patients who receive QT-prolonging drugs in hospital units with continuous ECG monitoring, TdP should be avoidable if there is an awareness of individual risk factors and the ECG signs of drug-induced LQTS. Particularly important are the ECG risk factors for TdP, including marked QTc prolongation to >500 ms (with the exception of amiodarone- or verapamil-induced QT prolongation), marked QT-U prolongation and distortion after a pause, onset of ventricular ectopy and couplets, macroscopic T-wave alternans, or episodes of polymorphic ventricular tachycardia that are initiated with a short-long-short R-R cycle sequence (typically, PVC-compensatory pause-PVC). Recognition of these ECG harbingers of TdP allows for treatment with intravenous magnesium, removal of the offending agent, and correction of electrolyte abnormalities and other exacerbating factors, including the prevention of bradycardia and long pauses with temporary pacing if necessary.
AB - TdP is an uncommon but potentially fatal arrhythmia that can be caused by drugs that cause selective prolongation of action potential durations in certain layers of the ventricular myocardium, which creates dispersion of repolarization and a long, distorted QT-U interval on the ECG. A summary of key points to remember is provided in Table 3. For patients who receive QT-prolonging drugs in hospital units with continuous ECG monitoring, TdP should be avoidable if there is an awareness of individual risk factors and the ECG signs of drug-induced LQTS. Particularly important are the ECG risk factors for TdP, including marked QTc prolongation to >500 ms (with the exception of amiodarone- or verapamil-induced QT prolongation), marked QT-U prolongation and distortion after a pause, onset of ventricular ectopy and couplets, macroscopic T-wave alternans, or episodes of polymorphic ventricular tachycardia that are initiated with a short-long-short R-R cycle sequence (typically, PVC-compensatory pause-PVC). Recognition of these ECG harbingers of TdP allows for treatment with intravenous magnesium, removal of the offending agent, and correction of electrolyte abnormalities and other exacerbating factors, including the prevention of bradycardia and long pauses with temporary pacing if necessary.
KW - AHA Scientific Statements
KW - acute care
KW - arrhythmia
KW - drugs
KW - electrocardiography
KW - electrophysiology
KW - torsade de pointes
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U2 - 10.1016/j.jacc.2010.01.001
DO - 10.1016/j.jacc.2010.01.001
M3 - Review article
C2 - 20185054
AN - SCOPUS:76949093249
SN - 0735-1097
VL - 55
SP - 934
EP - 947
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 9
ER -