Which ECG features suggest torsade de pointes?

Updated: Jan 31, 2017
  • Author: Jatin Dave, MD, MPH; Chief Editor: Mikhael F El-Chami, MD  more...
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Other electrocardiographic features helpful in diagnosing torsade include its typical mode of onset and its morphology, as follows:

  • Patients have paroxysms of 5-20 beats at a rate faster than 200 bpm; sustained episodes occasionally can be seen

  • Progressive change in polarity of QRS about the isoelectric line occurs

  • Complete 180° twist of QRS complexes in 10-12 beats is present

  • A short-long-short sequence between the R-R intervals occurs before the trigger response.

  • Patients may revert spontaneously or convert to a nonpolymorphic ventricular tachycardia or ventricular fibrillation

  • Occasionally, T-wave alternans may be seen before torsade

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