Machado C, Baga J J, Kawasaki R, Reinoehl J, Steinman R T, Lehmann M H
Arrhythmia Center, Division of Cardiology/Department of Internal Medicine, Sinai Hospital, Detroit, Michigan, USA.
J Electrocardiol. 1997 Jan;30(1):31-7. doi: 10.1016/s0022-0736(97)80032-5.
Subarachnoid hemorrhage is widely accepted as a potential cause of torsade de pointes (TdP), yet this putative etiologic relationship has never been systematically evaluated. We therefore undertook a MEDLINE search from 1966 through 1993, with relevant back referencing, and identified 20 cases of TdP in the setting of subarachnoid hemorrhage. It was impossible in any of these cases (usually because of insufficient data) to completely exclude one or more alternative explanations for TdP, including congenital long QT syndrome, hypokalemia, hypomagnesemia, or drug-induced QT prolongation. Furthermore, of a total of 1,139 patients in 16 prospective series of subarachnoid hemorrhage with electrographic analyses, there were only five reported cases of TdP, all in patients with hypokalemia. Thus, extremely limited scientific data exist to support the notion that subarachnoid hemorrhage can be a distinct cause of TdP. Until more definitive evidence is available, the development of TdP in patients with subarachnoid hemorrhage is probably better characterized as a multifactorial phenomenon occurring in an acute, typically intensive care, setting.
蛛网膜下腔出血被广泛认为是尖端扭转型室速（TdP）的一个潜在病因，然而这种假定的病因关系从未得到系统评估。因此，我们对1966年至1993年期间的MEDLINE进行了检索，并进行了相关的回溯引用，共识别出20例蛛网膜下腔出血情况下发生TdP的病例。在这些病例中，无一例能够完全排除TdP的一种或多种其他解释（通常是因为数据不足），这些解释包括先天性长QT综合征、低钾血症、低镁血症或药物诱导的QT间期延长。此外，在16个进行了心电图分析的蛛网膜下腔出血前瞻性系列研究中，总计1139例患者中，仅有5例TdP报告病例，所有病例均为低钾血症患者。因此，支持蛛网膜下腔出血可作为TdP一个独立病因这一观点的科学数据极为有限。在获得更确凿的证据之前，蛛网膜下腔出血患者发生TdP可能更宜被描述为一种在急性（通常是重症监护）环境中出现的多因素现象。
