Torsade de pointes is an uncommon ventricular tachyarrhythmia precipitated by a variety of metabolic and pharmacological conditions and requiring unconventional antiarrhythmic therapy. A case is presented demonstrating the occurrence of torsade de pointes following sotalol overdosage and specific features enabling recognition and treatment of this life-threatening arrhythmia are discussed.
SinghBNVaughan-WilliamsEM. A third class of antiarrhythmic action. Effects on atrial and ventricular intracellular potentials, and other pharmacological actions on cardiac muscle, of MJ 1999 and AH 3474. Br J Pharmacol1970; 39: 675–687.
2.
FrishmanWJacobHEisenbergERibnerH.Clinical pharmacology of the new beta-adrenergic blocking drugs. Part 8. Self-poisoning with beta-adrenoreceptor blocking agents: Recognition and management. Am Heart J1979; 98: 798–811.
3.
NeuvonenPJElonenEVuorenmaaTLaaksoM.Prolonged Q-T interval and severe tachyarrhythmias, common features of sotalol intoxication. Eur J Clin Pharmacol1981; 20: 85–89.
4.
BazettHC. An analysis of the time relations of electrocardiograms. Heart1920; 7: 353–370.
5.
McLeodAKitsonDMcComishMJewittD.Role of ambulatory monitoring; accuracy of quantitative analysis system. Br Heart J1977; 39: 347 (abstract)
6.
GarrettERSchnelleK.Separation and spectrofluorometric assay of the β-adrenergic blocker sotalol from blood and urine. J Pharm Sci1971; 60: 833–839.
7.
ElonenENeuvonenPJTarsannenLKalaR.Sotalol intoxication with prolonged Q-T interval and severe tachyarrhythmias. Br Med J1979; 1: 1184.
CurryPFitchettDStubbsWKriklerD.Ventricular arrhythmias and hypokalaemia. Lancet1976; 2: 231–233.
13.
KhanMMLoganKRMcCombJMAdgeyAAJ. Management of recurrent ventricular tachyarrhythmias associated with Q-T prolongation. Am J Cardiol1981; 47: 1301–1308.
14.
LoebHSPietrasRJGunnarRMTobinJR. Paroxysmal ventricular fibrillation in two patients with hypomagnesemia: Treatment by transvenous pacing. Circulation1968; 37: 210–215.
15.
SinghBNGaarderTDKanegaeTGoldsteinMMontgomerieJZMillsH.Liquid protein diets and torsade de pointes. JAMA1978; 240: 115–119.
16.
ReynoldsEWVander ArkCR. Quinidine syncope and the delayed repolarization syndromes. Mod Concepts Cardiovasc Dis1976; 45: 117–122.
17.
StrasbergBSclarovskySErdbergAProcainamide-induced polymorphous ventricular tachycardia. Am J Cardiol1981; 47: 1309–1314.
18.
MeltzerRSRobertEWMcMorrowMMartinRP. Atypical ventricular tachycardia as a manifestation of disopyramide toxicity. Am J Cardiol1978; 42: 1049–1053.
19.
SmithWMGallagherJJ. ‘Les torsades de pointes’: An unusual ventricular arrhythmia. Ann Intern Med1980; 93: 578–584.
20.
TottermanKJTurtoHPellinenT.Overdrive pacing as treatment of sotalol-induced ventricular tachyarrhythmias (Torsade de pointes). Acta Med Scand (Suppl)1982; 688: 28–33.
21.
TzivoniDKerenASternS.Torsade de pointes versus polymorphous ventricular tachycardia. Am J Cardiol1983; 52: 639–640.
22.
BedellSEDelbancoTLCookEFEpsteinFH. Survival after cardiopulmonary resuscitation in the hospital. N Engl J Med1983; 309: 569–576.