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

Barbara J. Drew, Michael J. Ackerman, Marjorie Funk, W. Brian Gibler, Paul Kligfield, Venu Menon, George J. Philippides, Dan M. Roden, Wojciech Zareba

Research output: Contribution to journalReview article

190 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)934-947
Number of pages14
JournalJournal of the American College of Cardiology
Volume55
Issue number9
DOIs
StatePublished - Mar 2 2010

Keywords

  • AHA Scientific Statements
  • acute care
  • arrhythmia
  • drugs
  • electrocardiography
  • electrophysiology
  • torsade de pointes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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