Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA.
Division of Research, Kaiser Permanente, Oakland, CA, USA.
Ann Noninvasive Electrocardiol. 2022 Jan;27(1):e12888. doi: 10.1111/anec.12888. Epub 2021 Sep 21.
TdP is a form of polymorphic ventricular tachycardia which develops in the setting of a prolonged QT interval. There are limited data describing risk factors, treatment, and outcomes of this potentially fatal arrhythmia.
Our goals were as follows: (1) to validate cases presenting with Torsade de Pointes (TdP), (2) to identify modifiable risk factors, and (3) to describe the management strategies used for TdP and its prognosis in a real-world healthcare setting.
Case-control study (with 2:1 matching on age, sex, and race/ethnicity) nested within the Genetic Epidemiology Research on Aging (GERA) cohort. Follow-up of the cohort for case ascertainment was between January 01, 2005 and December 31, 2018.
A total of 56 cases of TdP were confirmed (incidence rate = 3.6 per 100,000 persons/years). The average (SD) age of the TdP cases was 74 (13) years, 55 percent were female, and 16 percent were non-white. The independent predictors of TdP were potassium concentration <3.6 mEq/L (OR = 10.6), prior history of atrial fibrillation/flutter (OR = 6.2), QTc >480 ms (OR = 4.4) and prior history of coronary artery disease (OR = 2.6). Exposure to furosemide and amiodarone was significantly greater in cases than in controls. The most common treatment for TdP was IV magnesium (78.6%) and IV potassium repletion (73.2%). The in-hospital and 1-year mortality rates for TdP cases were 10.7% and 25.0% percent, respectively.
These findings may inform quantitative multivariate risk indices for the prediction of TdP and could guide practitioners on which patients may qualify for continuous ECG monitoring and/or electrolyte replacement therapy.
TdP 是一种多形性室性心动过速，发生在 QT 间期延长的情况下。关于这种潜在致命性心律失常的危险因素、治疗和结局的数据有限。
我们的目标如下：（1）验证 Torsade de Pointes（TdP）的病例，（2）确定可改变的危险因素，（3）描述在真实医疗环境中 TdP 及其预后的管理策略。
病例对照研究（按年龄、性别和种族/民族以 2:1 匹配）嵌套在遗传流行病学研究老龄化（GERA）队列中。对队列的随访以确定病例，时间范围为 2005 年 1 月 1 日至 2018 年 12 月 31 日。
共确诊 56 例 TdP（发病率为 3.6/100000 人/年）。TdP 病例的平均（SD）年龄为 74（13）岁，55%为女性，16%为非白人。TdP 的独立预测因素是钾浓度<3.6 mEq/L（OR=10.6）、既往心房颤动/扑动史（OR=6.2）、QTc>480 ms（OR=4.4）和既往冠心病史（OR=2.6）。与对照组相比，呋塞米和胺碘酮的暴露明显更高。TdP 的最常见治疗方法是静脉注射镁（78.6%）和静脉补钾（73.2%）。TdP 病例的住院和 1 年死亡率分别为 10.7%和 25.0%。
这些发现可能为 TdP 的定量多变量风险指数提供信息，并指导临床医生确定哪些患者可能符合连续心电图监测和/或电解质替代治疗的条件。
