Torsade de pointes: the long-short initiating sequence and other clinical features: observations in 32 patients.
Torsade de pointes: the long-short initiating sequence and other clinical features: observations in 32 patients.
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尖端扭转型室速：长短起始序列和其他临床特征：32 名患者的观察结果。
DOI：
10.1016/s0735-1097(83)80226-5
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发表时间：
1983
影响因子：
24
通讯作者：
Waldo,AL
中科院分区：
文献类型：
--
作者：
Kay,GN;Plumb,VJ;Arciniegas,JG;Henthorn,RW;Waldo,AL
回顾性分析32例尖端扭转型室性心动过速患者的临床背景、诱发因素、心电图特征和治疗反应。31例患者有基础心脏病，30例患者有既往基础心律失常。抗心律失常药物，通常与电解质异常（如低钾血症和低镁血症）是最常见的诱发因素。在26例患者中，发现22例抗肿瘤药物的血清药物水平在治疗范围内。然而，在给予已知可延长QT间期的药物前，32例患者中有20例单独或联合出现基线QT间期延长、低钾血症或低镁血症。所有患者在发生尖端扭转型室性心动过速前即刻均发生QTC间期延长（平均0.59秒）。T波形态明显不稳定。心脏起搏是唯一持续有效的治疗方式，44例尖端扭转型室性心动过速发作中，41例以特征性长短心室周期作为起始序列。报告的数据支持尖端扭转型室性心动过速心电图特征的高频率，可对其发作进行分析。这表明，这一心电图特征将有助于建立尖端扭转型室性心动过速的诊断，并将其与其他多形性室性心动过速区分开来。
The clinical setting, precipitating factors, electrocardiographic features and response to treatment of 32 patients with torsade de pointes were reviewed. Thirty-one patients had underlying cardiac disease and 30 patients had a previous underlying cardiac arrhythmia. Antiarrhythmic medications, often in association with electrolyte abnormalities (such as hypokalemia and Hypomagnesemia) were the most common precipitating factors. In 22 of 26 patients, the serum drug levels of the antiarrhythmic agents were found to be within the therapeutic range. However, before the administration of agents known to prolong the QT interval, 20 of the 32 patients had, either alone or in combination, baseline prolongation of the QT interval, hypokalemia or Hypomagnesemia. All patients had QTC interval prolongation (mean 0.59 second) immediately before the development of torsade de pointes. Marked lability of T wave morphology was frequently noted. Cardiac pacing was the only consistently effective mode of therapy.A characteristic long-short ventricular cycle length as the initiating sequence was found in 41 of 44 episodes of torsade de pointes. Reported data support the high frequency of this electrocardiographic feature of torsade de pointes in which its onset could be analyzed. It is suggested that this electrocardiographic characteristic will aid in both establishing the diagnosis of torsade de pointes and distinguishing it from other polymorphic forms of ventricular tachycardia.
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