Summary
It is suggested that torsades de pointes may be only one of a group of arrhythmias that are characterized by being pause induced or bradycardia induced. A distinction is made between the cause of the “twisting of the points” and the cause of the action potentials that initiate and sustain the tachycardia. It is pointed out that torsades de pointes and other pause-induced arrhythmias share many features with rhythmic activity arising from early afterdepolarizations. Both are seen after pauses or at low rates, both are seen in quinidine intoxication, and both are seen in hypokalemia. The short-long-short sequence that is seen in torsades de pointes and certain other pauseor bradycardia-induced arrhythmias can be fully explained by the behavior of rhythmic activity initiated and sustained by early afterdepolarizations, as can the abrupt onset and termination of pause-induced arrhythmias and their tendency to show initial warming up and terminal slowing down.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Dessertenne F. La tachycardia ventriculaire a deux foyers opposes variables.Arch Mal Coeur 1966;59:263–272.
Surawicz B. Electrophysiologic substrate of torsade de pointes: Dispersion of repolarization or early afterdepolarizations?J Am Coll Cardiol 1989;14:172–184.
Brachmann J, Scherlag BJ, Rosenshtraukh LV, et al. Bradycardia-dependent triggered activity: Relevance to drug-induced multiform ventricular tachycardia.Circulation 1983;68:846–856.
Cranefield PF, Aronson RS.Cardiac arrhythmias: The role of triggered activity and other mechanisms. Mount Kisco, NY: Futura Publishing, 1988.
Cranefield PF, Aronson RS. Torsade de pointes and other pause-induced ventricular tachycardias: The short-longshort sequence and early afterdepolarizations.PACE 1988;11:670–678.
Jackman WM, Clark M, Friday KJ, et al. Ventricular tachyarrhythmias in the long QT syndromes.Med Clin North Am 1984;68:1079–1109.
Bardy GH, Ungerleider RM, Smith WM, et al. A mechanism of torsade de pointes in a canine model.Circulation 1983;67:52–59.
Bhandari AK, Scheinman M. The long QT syndrome.Mod Conc Cardiovasc Dis 1985;54:45–50.
Nguyen PT, Scheinman MM, Seger J. Polymorphous ventricular tachycardia: Clinical characterization, therapy and the QT interval.Circulation 1986;74:340–349.
Dessertenne F, Coumel P, Fabiato, A. Fibrillation ventriculaire et torsades de pointes.La Presse Medicale 1969; 77:193–196.
Kay GN, Plumb VJ, Arciniegas JG, et al. Torsade de pointes: The long-short initiating sequence and other clinical features: Observations in 32 patients.J Am Coll Cardiol 1983;2:806–817.
Roden DM, Thompson KA, Hoffman BF, et al. Clinical features and basic mechanisms of quinidine induced arrhythmias.J Am Coll Cardiol 1986;8:73A-78A.
Roden DM, Woosley RL, Primm RK. Incidence and clinical features of the quinidine-associated long QT syndrome. Implications for patient care.Am Heart J 1986;111:1088–1093.
Leclercq JF, Maisonblanche P, Cauchemez B, et al. Respective role of sympathetic tone and of cardiac pauses in the genesis of 62 cases of ventricular fibrillation recorded during Holter monitoring.Eur Heart J 1988;9:1276–1283.
Coumel P, Leclercq J-F, Slama R. Repetitive monomorphic idiopathic ventricular tachycardia. In: Zipes DP, Jalife J, eds.Cardiac electrophysiology and arrhythmias. Orlando, FL: Grune and Stratton, 1985:457–468.
Zimmermann M, Maisonblanche P, Cauchemez B, et al. Determinants of the spontaneous ectopic activity in repetitive monomorphic idiopathic ventricular tachycardia.J Am Coll Cardiol 1986;7:1219–1227.
Coumel P, Leclercq J-F, Zimmermann M, et al. Antiarrhythmic therapy: Noninvasive guided strategy versus empirical or invasive strategies. In: Brugada P, Wellens HJJ, eds.Cardiac arrhythmias: Where to go from here? Mount Kisco, NY: Futura Publishing, 1987:403–419.
Gavrilescu S, Luca C. Right ventricular monophasic action potentials in patients with the long QT syndrome.Br Heart J 1978;40:1014–1018.
Bonatti V, Rolli A, Botti G. Recordings of monophasic action potentials of the right ventricle in long QT syndromes complicated by severe ventricular arrhythmias.Eur Heart J 1983;4:168–179.
Bonatti V, Rolli A, Botti G. Monophasic action potential studies in human subjects with prolonged ventricular repolarization and long QT syndromes.Eur Heart J 6 (Suppl. D) 1985:131–143.
Levine JH, Spear JF, Guarnieri T, et al. Cesium chlorideinduced long QT syndrome: Demonstration of afterdepolarizations and triggered activity in vivo.Circulation 1985;72: 1092–1103.
Author information
Authors and Affiliations
Additional information
Supported in part by a grant to P.F. Cranefield from the National Heart, Lung and Blood Institute, HL-14899 and in part by a grant to R.S Aronson from the National Heart, Lung and Blood Institute, HL-32688.
Rights and permissions
About this article
Cite this article
Cranefield, P.F., Aronson, R.S. Torsades de pointes and early afterdepolarizations. Cardiovasc Drug Ther 5, 531–537 (1991). https://doi.org/10.1007/BF03029780
Issue Date:
DOI: https://doi.org/10.1007/BF03029780