Under what circumstances might torsade de pointes fail to appear on electrocardiography?

Updated: Jan 31, 2017
  • Author: Jatin Dave, MD, MPH; Chief Editor: Mikhael F El-Chami, MD  more...
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Torsade occurring in the setting of acquired long QT syndrome is preceded by pauses in almost all cases. In congenital long QT syndrome (adrenergic-dependent), pause dependence is found in most of the adult cases, whereas onset of torsade is not pause-dependent in children.

Failure to identify this rhythm may occur for various reasons. During very short runs of torsade, the typical twisting of the QRS complexes around the isoelectric line may not be apparent. Early events usually are short-lived. In the case of a single-lead recording, the typical morphology of torsade may not be obvious.

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