What are the medications used for long-term treatment of torsade de pointes?

Updated: Jan 31, 2017
  • Author: Jatin Dave, MD, MPH; Chief Editor: Mikhael F El-Chami, MD  more...
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Beta-adrenergic antagonists at maximally tolerated doses are used as a first-line long-term therapy in congenital long QT syndrome. Propranolol is used most extensively, but other agents such as esmolol or nadolol also can be used. Beta-blockers should be avoided in those congenital cases in which bradycardia is a prominent feature. Beta-blockers are contraindicated in acquired long QT syndrome because bradycardia produced by these agents can precipitate torsade. One approach to assess the adequacy of beta-blockade is by exercise testing. One investigator recommends aiming for at least a 20% reduction in maximum heart rate compared to that of the baseline (pre-beta blocker therapy). Another approach is to check the blood levels of beta blockers (eg, propranolol) when possible. [21]

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