Torsades de Pointes
Torsades de pointes is a syndrome of polymorphic ventricular arrhythmia occurring in the setting of marked prolongation of the electrocardiographic QT interval. It occurs in individuals with genetic mutations in genes that control expression of sodium or potassium channels and is a frequent cause of sudden death in these individuals. It also occurs as a complication of drugs that prolong the QT interval by blockade of potassium channels.
Over forty marketed drugs and an equivalent number of drugs under development have been found to block potassium channels, prolong the QT interval and induce, in some individuals, torsades de pointes (QT Drug List). Drug-induced torsades de pointes is a relatively rare event but can be as high as 2-3% with some drugs.1,2
A great deal has been learned about the inherited long QT syndrome through the collection of data in an international registry.3-5 Far less is known about the drug-induced syndrome because of the infrequent nature of the occurrence and the absence of a comprehensive data base. Only 1% of serious adverse reactions to drugs are ever reported to the Food and Drug Administration (FDA).
Arizona CERT has developed an international registry for cases of drug-induced torsades de pointes. For more information about this registry, please visit About the Registry.
References:
- Hohnloser SH, Woosley RL. Sotalol. N Engl J Med 1994; 331:31-38.
- Ebert SN, Liu XK, Woosley RL. Female gender as a risk factor for drug-induced cardiac arrhythmias: evaluation of clinical and experimental evidence. J Womens Health 1998; 7(5):547-557.
- Zareba W, Moss AJ, Le Cessie S, Locati EH, Robinson JL, Hall WJ et al. Risk of cardiac events in family members of patients with Long QT syndrome. J Am. College Cardiol 1995; 26(7):1685-1691.
- Schwartz PJ, Moss AJ, Vincent GM, Crampton RS. Diagnostic criteria for the long QT syndrome: An update. Circ 1993; 88:782-784.
- Moss AJ, Schwartz PJ, Crampton RS, Tzivoni D, Locati EH, MacCluer J et al. The long QT syndrome. Prospective longitudinal study of 328 families. Circ 1991; 84(3):1136-1144.
