Torsades de pointes is a medical condition, the name of which means in French "twisting of the points". It is a potentially deadly form of ventricular tachycardia. On the electrocardiogram (ECG/EKG), it will present like ventricular tachycardia, but the QRS complexes will swing up and down around the baseline in a chaotic fashion, which prompted the name.

Causes

The primary cause for torsades de pointes is hypomagnesemia (low blood levels of magnesium). It is commonly seen in malnourished individuals like alcoholics, as chronic abuse of alcohol will lead to low levels of magnesium, calcium, thiamine, and other nutrients.

Factors that are associated with an increased tendency toward torsades de pointes include:

• Agents that increase the QT interval
• Hypokalemia
• Hypomagnesemia
• Hypoxia / acidosis
• Left ventricular dysfunction
• Heart failure
• Left ventricular hypertrophy
• Slow heart rate
• Female gender
• Long baseline QT interval
  • Familial long QT syndrome

Treatment

Acute treatment is with withdrawal of the offending agent (if related to medication), infusion of magnesium sulfate, defibrillation/cardioversion and antiarrhythmic drugs.

History and terminology

The French term is largely due to the fact that the phenomenon was originally described in a French medical journal by Dessertenne in 1966.

References

• Dessertenne F. Ventricular tachycardia with two variable opposing foci. Arch Mal Coeur Vaiss 1966;59:263-72. PMID 4956181.