Torsades de Pointes

What is Torsades de Pointes?

Torsades de Pointes is a type of very fast heart rhythm (tachycardia) that starts in your heart’s lower chambers (ventricles). Unlike a normal pulse rate of 60 to 100 beats a minute, a fast heartbeat in your ventricles (ventricular tachycardia) is more than 100 beats a minute. Torsades de Pointes can lead to a heart rate anywhere between 150 to 300 beats a minute.

People who have Long QT interval (seen on the electrocardiogram), an electrical problem with their heart, tend to get Torsades de Pointes. Genetic abnormalities or sometimes certain medicines can cause Long QT interval.

If you have a Long QT interval and your ventricles get an extra contraction during the time when they’re supposed to be getting ready for the next one, you may get Torsades de Pointes.

What is the difference between Torsades de Pointes and ventricular fibrillation?

Torsades de Pointes is actually ventricular tachycardia that happens in the setting of Long QT interval. During Torsades de Pointes, your provider can see a specific pattern of ventricular tachycardia that looks like twisting points or peaks (which is what the name means in French) on an electrocardiogram (EKG). Torsades de Pointes can lead to ventricular fibrillation, which can be deadly.

Who does Torsades de Pointes affect?

You can get Torsades de Pointes if you inherited Long QT syndrome or if you take certain medicines that can cause Long QT interval.

How common is Torsades de Pointes?

Researchers aren’t sure how many people get Torsades de Pointes from medicines, but getting Long QT syndrome from medicines is common. This can put you at risk for Torsades de Pointes.

Anywhere from one in 2,000 people to one in 20,000 people may have been born with a genetic problem that can lead to Torsades de Pointes.

What are the symptoms of Torsades de Pointes?

Half of the people with Torsades de Pointes don’t have any symptoms. People who get symptoms can experience:

• Dizziness.
• Palpitations (Feeling your heart pounding).
• Lightheadedness.
• Syncope (Fainting).
• Cardiac arrest.
• Sudden cardiac death.

What causes Torsades de Pointes?

Some people are born with Long QT syndrome, which can lead to Torsades de Pointes. More often, medicines can cause Torsades de Pointes.

Medicines that can cause Torsades de Pointes include:

• Antifungals.
• Antibiotics.
• Antipsychotics.
• Antiemetics (for nausea and vomiting).
• Antiarrhythmics.
• Cancer medicines.

What puts me at a higher risk for Torsades de Pointes?

Some risk factors are harder to control than others. Risk factors include:

• Having Long QT syndrome that you inherited from your parents.
• Having heart disease.
• Being a woman.
• Being older than 65.
• Taking diuretics.
• Having profound bradycardia (very slow heart rate).
• Having low levels of calcium, magnesium or potassium.
• Having excessive diarrhea and vomiting.

What are the complications of Torsades de Pointes?

Complications of Torsades de Pointes include:

• Ventricular fibrillation.
• Syncope (fainting).
• Sudden cardiac death.

How is Torsades de Pointes diagnosed?

Your provider can see a distinct pattern that looks like twisting points or peaks (which it means in French) on an electrocardiogram (EKG).

What tests will be done to diagnose Long QT interval and Torsades de Pointes?

Tests to diagnose Long QT interval include:

• Electrocardiogram (EKG).
• Blood tests to check electrolyte levels.
• Echocardiogram.
• A heart monitor you wear at home.

How is Torsades de Pointes treated?

You will stay in the hospital until your unusual heart rhythm is under control. Your provider may stop giving you medicines that could cause Torsades de Pointes and use other medicines and/or medical devices to help you.

If you inherited Long QT syndrome from your parents, your treatment will include more long-term solutions than someone who got Long QT syndrome from a medication.

What medications are used for Torsades de Pointes?

Depending on your situation, your provider may give you:

• Magnesium and/or potassium.
• Isoproterenol.
• Beta blockers like Nadolol (Corgard®).

What treatments are used for Torsades de Pointes?

Your provider may use one of the following medical devices:

• Temporary or permanent cardiac pacemaker.
• Implantable cardioverter defibrillator (ICD).
• Electrical cardioversion.
• Defibrillation.

Complications of the treatment

Any surgery can have complications, but it’s worth the risk to give your heart a normal rhythm. It may save your life.

How do I take care of myself with Torsades de Pointes?

With a Torsades de Pointes diagnosis, you can take care of yourself in these ways:

• Talk to a heart rhythm specialist about exercise if you were born with certain types of Long QT syndrome.
• Take your medicines as your provider instructed.
• Keep track of your pulse and know what’s normal.
• Wear a heart monitor if your provider gave you one.

How can I reduce my risk of Torsades de Pointes?

You can reduce your risk of Torsades de Pointes in these ways:

• Stop taking medicines that can cause Long QT syndrome. (Your provider can find an alternative.)
• Increase your levels of calcium, magnesium and potassium if your provider recommends it.

How can I prevent Torsades de Pointes?

If Long QT syndrome runs in your family, a healthcare provider can test your family members to see if they have it.

Avoid medications that can cause Long QT interval and can put you at risk for Torsades de Pointes.

What can I expect if I have Torsades de Pointes?

Your fast heart rhythm (ventricular tachycardia) from Torsades de Pointes often stops by itself, but it will come back often. It can also lead to sustained ventricular fibrillation if you don’t get treatment.

How long does Torsades de Pointes last?

Without treatment, Torsades de Pointes can keep coming back or may lead to ventricular fibrillation, which can be deadly.

What is the outlook for Torsades de Pointes?

If you don’t get treatment, Torsades de Pointes could be deadly. With treatment, your chances of survival are good, especially if you stop taking the medicine that caused Long QT interval.

How do I take care of myself with Torsades de Pointes?

There are several things you should do to take care of yourself with Torsades de Pointes.

• If you inherited Long QT syndrome from a parent, you should talk to a heart rhythm specialist before your start exercising.
• Keep taking your medicines to keep Torsades de Pointes from happening again.
• Learn how to take your pulse and what’s normal.
• Eat a diet rich in magnesium and potassium.
• Drink plenty of fluids.
• If your provider gave you a heart monitor to use, be sure to wear it.

When should I see my healthcare provider?

Because of your risk of sudden death, you need to be sure to keep your follow-up appointments with your provider. Also, let your provider know if you’ve had bad side effects from medicines.

When should I go to the ER?

You should go to the ER if you have a very fast pulse rate or if you feel palpitations, dizziness or lightheadedness or you get fainting episodes.

What questions should I ask my doctor?

• Did I get Long QT syndrome from my parents or from a medication?
• What are the chances that others in my family will get Long QT syndrome?
• Is there another medicine I can take instead of the one that put me at risk for Torsades de Pointes?

A note from Cleveland Clinic

Torsades de Pointes can be dangerous if it’s not treated. But your outlook is good if you follow your provider’s instructions and keep your follow-up appointments. Getting basic life support training for your family may give you peace of mind in case you need help.