Nanimatsu H, Shibayama H, Koumatsu A, Inoue T, Maeda T, Saikawa T, Ito S, Takaki R, Tsunematsu Y
Kokyu To Junkan. 1989 May;37(5):535-9.
Torsades de Pointes is an atypical ventricular tachycardia, a characteristic sinusoidal twisting of QRS complex around the base line, first described by Dessertenne et al in 1966. Since their original description, many literatures including both reviews and case reports have been issued. However, the exact causes, mechanism and its true relation to usual ventricular tachycardia and fibrillation remain to be elucidated. In the present report, three cases of Torsades de Pointes (TDP) were described. All these patients revealed a prolonged QT and QTc interval as has been recognized at the occasion of TDP attacks together with low serum potassium concentration. In addition, one had hypertrophic cardiomyopathy (case 1), cholelithiasis (case 2) and uterus cancer (case 3), respectively. Regarding to the treatment, direct current counter shock was applied to terminate the TDP in all 3 cases, the correction of low serum potassium concentration was also done in each case. Lidocaine was ineffective in case 3 to terminate the TDP, while verapamil was effective in case 3 to convert TDP to normal sinus rhythm. In case 2, no antiarrhythmic drugs were applied, however, cardiac massage and normalization of serum potassium concentration succeeded to recover normal sinus rhythm. The diversity of the causes and treatments of TDP in these three cases was discussed in relation to the genesis of TDP.
尖端扭转型室速是一种非典型的室性心动过速，其特征为QRS波群围绕基线呈正弦样扭转，于1966年由 Dessertenne 等人首次描述。自最初描述以来，已发表了许多包括综述和病例报告在内的文献。然而，其确切病因、机制及其与常见室性心动过速和颤动的真实关系仍有待阐明。在本报告中，描述了3例尖端扭转型室速（TDP）。所有这些患者在TDP发作时均出现QT和QTc间期延长，同时血清钾浓度降低。此外，分别有1例患有肥厚型心肌病（病例1）、胆结石（病例2）和子宫癌（病例3）。关于治疗，所有3例均应用直流电复律来终止TDP，并且每例均纠正了低血清钾浓度。利多卡因对病例3终止TDP无效，而维拉帕米对病例3将TDP转为正常窦性心律有效。在病例2中，未应用抗心律失常药物，然而，心脏按摩和血清钾浓度正常化成功恢复了正常窦性心律。结合TDP的发生机制讨论了这3例TDP病因和治疗的多样性。
