Prevention of torsade de pointes in hospital settings: a scientific statement from the American Heart Association and the American College of Cardiology Foundation.
Prevention of torsade de pointes in hospital settings: a scientific statement from the American Heart Association and the American College of Cardiology Foundation.
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DOI：
10.1161/circulationaha.109.192704
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发表时间：
2010-03-02
期刊：
影响因子：
37.8
通讯作者：
American Heart Association Acute Cardiac Care Committee of the Council on Clinical Cardiology, the Council on Cardiovascular Nursing, and the American College of Cardiology Foundation
中科院分区：
文献类型：
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作者：
Drew BJ;Ackerman MJ;Funk M;Gibler WB;Kligfield P;Menon V;Philippides GJ;Roden DM;Zareba W;American Heart Association Acute Cardiac Care Committee of the Council on Clinical Cardiology, the Council on Cardiovascular Nursing, and the American College of Cardiology Foundation
然而，这种特征性扭曲形态可能并非在所有ECG导联中都很明显。其次，药物诱导的TdP发作通常以短-长-短的RR周期模式开始，包括短偶联早室复合体（PVC），随后是代偿性暂停，然后是另一个PVC，通常在T波峰值附近下降。2然而，由于潜在的长qt间期，这种R-on-T型PVC不具有特发性心室颤动所特有的短耦合间期。在离体犬心室楔制剂的实验基础上，这种短-长-短序列被认为通过增加心肌壁复极的异质性来促进TdP。第三，TdP发作通常表现为预热现象，室性心动过速的前几次搏动比随后的心律失常复合体表现出更长的周期长度。TdP的频率为每分钟160 ~ 240次，比心室颤动慢。第四，与不除颤而不终止的心室颤动不同，TdP经常自发终止，最后2到3次跳动显示心律失常减慢。然而，在某些病例中，TdP退化为心室颤动并导致心源性猝死。“点扭转”一词也被用于描述QT间期不延长的多形性室性心律失常。然而，这个术语最好局限于那些具有明显（500 ms） qt间隔延长和QT-U畸形的多态心动过速，因为它们似乎是一个独特的机制和治疗实体。
however, this characteristic twisting morphology may not be evident in all ECG leads. Second, episodes of drug-induced TdP usually start with a short-long-short pattern of RR cycles consisting of a short-coupled premature ventricular complex (PVC) followed by a compensatory pause and then another PVC that typically falls close to the peak of the T wave. 2 However, because of the underlying long-QT interval, this R-on-T PVC does not have the short coupling interval that is characteristic of idiopathic ventricular fibrillation. On the basis of experiments performed in isolated canine ventricular wedge preparations, this short-long-short sequence is thought to promote TdP by increasing heterogeneity of repolarization across the myocardial wall. Third, TdP episodes usually show a warm-up phenomenon, with the first few beats of ventricular tachycardia exhibiting longer cycle lengths than subsequent arrhythmia complexes. The rate of TdP ranges from 160 to 240 beats per minute, which is slower than ventricular fibrillation. Fourth, in contrast to ventricular fibrillation that does not terminate without defibrillation, TdP frequently terminates spontaneously, with the last 2 to 3 beats showing slowing of the arrhythmia. However, in some cases, TdP degenerates into ventricular fibrillation and causes sudden cardiac death.The term torsade de pointes has also been used to describe polymorphic ventricular arrhythmias in which QT intervals are not prolonged. However, the term is better confined to those polymorphic tachycardias with marked (500 ms) QT-interval prolongation and QT-U deformity, because they appear to be a distinct mechanistic and therapeutic entity.