Sotalol Torsades de Pointes
Report:
Sinus rhythm 67/min
Borderline first degree AV block
PR 0.20”
VEBs, frequent
Runs (3-beat, 5-beat) of multiform ventricular tachycardia
Incomplete LBBB
Prolonged QT interval
Comment:
The patient’s torsades (Fig 56a) were treated by MgSO4, then xylocaine, then DC countershock in CCU. Sotalol has now replaced flecainide as leading cause of iatrogenous torsades in this hospital. Drug-induced (acquired) long QT syndrome has been reviewed recently54.
The important distinction between torsade de pointes and multiform VT rests on underlying bradycardia and prolonged QT interval being associated with the former. In sustained tachycardia, the observation of “spindles” and axis rotation does not distinguish between the two. A representative 12-lead ECG in sinus rhythm is shown below (Fig 56b).
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