Torsade de Pointes?

Report:

Sinus/junctional rhythm

SVEBs

R-on-T VEBs

Runs of multiform ventricular tachycardia ? torsade de pointes

Comment:

The purists are probably correct in reserving the name torsade(s) de pointes for multiform VT with swinging axis and a background of bradycardia and prolonged QTc. The strips shown may not qualify: the last criterion is absent (although a 12-lead ECG would be needed to confirm this). The bradycardia itself is mostly due to the frequent SVEBs and VEBs.

This morphology (Marriott’s swinging pattern) indicates ectopic ventricular origin and is inconsistent with aberrant conduction. Whether a singular or a plural form of the now established French name should be used remains a moot point41. Another diagnostic point about ventricular ectopic origin is illustrated by the relationship of the VEBs (qR morphology) vs. the SVEBs (rS morphology) to the T wave: R-on-T (Q-on-T here) remains a sign of ventricular ectopy.

Faster sinus rate did not seem to be protective against the paroxysms (Fig 41a). Magnesium did not help, either: it was used for the wrong rhythm. Her calcium was initially low, but normalised by exogenous calcium; at any rate, hypocalcæmia does not appear to be arrhythmogenic per se. Hypocalcæmia, unlike other causes of QT prolongation, leaves the T wave relatively unchanged. The temporal dispersion of repolarisation potentials is minimal: hence the rarity of ventricular arrhythmias42.