Torsade de Pointes
Report:
Torsade de pointes ventricular tachycardia 270/min
Comment:
The patient became understandably restless in the middle of the recording.
This is a rare example of 12-lead ECG during torsade de pointes tachycardia. It is immediately apparent (movement artefact notwithstanding) that some leads show more uniform morphology than others. The same is true of bidirectional VT, alternans or any rhythm with variable QRS morphology or axis.
Impressive QT interval prolongation (0.50”) is shown in the preceding sinus rhythm ECG (Fig 95a). It is most likely due to sotalol, which has replaced flecainide as the commonest cause (at Woden Valley Hospital) of drug-induced ventricular tachycardia since the CAST trial. For some reason, amiodarone, although prolonging the QT interval, very rarely causes torsade de pointes. Sotalol causes it in 2-4% cases91. More in Canberra.
The patient did well with ventricular pacing and withdrawal of sotalol.
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