Milon D, Daubert J C, Saint-Marc C, Gouffault J
Ann Fr Anesth Reanim. 1982;1(5):513-20. doi: 10.1016/s0750-7658(82)80094-4.
A retrospective study of 54 torsades de pointe cases in a cardiology department enabled us to specify the main characteristics of this serious arrythmia often observed in intensive care units: --the diagnostic criteria: more than the pattern of tachycardia attack, late ventricular premature beats and particularly QT prolongation are necessary for proper diagnosis. These two criteria allow us to differentiate between torsades de pointe and multiform ventricular tachycardia with similar morphology especially in acute myocardial ischaemia; --their clinical repercussion: the shortness of circulatory arrest related to the spontaneous end of the arrythmia explains that the torsades de pointe often result in short faintings. Nevertheless, they may degenerate into ventricular fibrillation (17 p. 100) which, in cases of recurrence, induced four deaths in this study; --there are many possible aetiologies often associated (30 p. 100) in the same patient. Their research must be exhaustive in each case. The chronic bradycardias especially the atrioventricular blocks of two or three degree whether continuous or not are often responsible (57 p. 100). Then, the metabolic disorders, essentially hypokalaemia and constant drug administration (antiarrythmic agents belonging to group I of Vaughan William's classification, some antianginal drugs, vasodilatator drugs) are often chief causative agents. Other aetiologies are rare. In 9 p. 100 of cases, no aetiological factor is found; --the best treatment is to suppress aetiological factors, to stop the administration of antiarrhythmic drugs; torsades de pointe must be controlled by increasing the heart rate; pace maker stimulation is the best way of making QT shorter and thus of synchronizing ventricular depolarization.
对某心内科54例尖端扭转型室速病例进行的一项回顾性研究，使我们能够明确这种在重症监护病房中经常观察到的严重心律失常的主要特征：——诊断标准：除心动过速发作模式外，室性早搏晚期，尤其是QT间期延长，对于正确诊断是必要的。这两个标准使我们能够区分尖端扭转型室速和形态相似的多形性室性心动过速，尤其是在急性心肌缺血时；——它们的临床影响：心律失常自发终止导致的循环骤停时间短暂，这解释了尖端扭转型室速常导致短暂晕厥。然而，它们可能恶化为心室颤动（100例中有17例），在本研究中，复发情况下有4例死亡；——同一患者常有多种可能的病因（100例中有30例）。在每种情况下，对病因的排查都必须详尽。慢性心动过缓，尤其是二度或三度房室传导阻滞，无论是否持续，往往是病因（100例中有57例）。其次，代谢紊乱，主要是低钾血症和持续用药（属于Vaughan William分类I组的抗心律失常药物、一些抗心绞痛药物、血管扩张药物）往往是主要病因。其他病因则较为罕见。100例中有9例未发现病因；——最佳治疗方法是消除病因，停止使用抗心律失常药物；必须通过提高心率来控制尖端扭转型室速；起搏器刺激是使QT间期缩短从而使心室去极化同步的最佳方法。
