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Drug-induced torsades de pointes: clinical and experimental observations bearing on mechanism

  • Chapter
Book cover Ventricular Tachycardias

Part of the book series: Developments in Cardiovascular Medicine ((DICM,volume 71))

Abstract

Torsades de pointes associated with the administration of quinidine or other class 1A antiarrhythmic agents, phenothiazines, or tricyclic antidepressants is a very distinctive and unusual ventricular tachyarrhythmia. It occurs in the setting of pronounced QTU interval prolongation and has a characteristic pause-related pattern of initiation [1–6]. The incidence of this arrhythmia does not seem to increase with increasing severity of ventricular disease, and may occur in patients with seemingly normal hearts [6–8]. Similarly, the incidence does not seem to increase with increasing drug dose. Torsades de pointes typically occurs at usual or low doses and serum drug levels [3–5, 9–14], and may occur after months of uncomplicated drug therapy without the appearance of other known inciting factors, such as hypokalemia and hypomagnesemia [5, 6, 15]. Susceptible patients have a high risk of recurrence of this arrhythmia upon exposure to any of the other drugs which broaden the T wave and enhance the U wave [5, 14, 16–21], whereas the majority of patients will not develop torsades de pointes regardless of the number of agents tried.

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Authors and Affiliations

  1. Department of Medicine, University of Oklahoma Health Sciences Center and the Veterans Administration Medical Center, Oklahoma City, Oklahoma, USA

    Karen J. Friday, Bela Szabo, Eugene Patterson, Etienne M. Aliot & Ralph Lazzara

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  1. Warren M. Jackman
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  2. Karen J. Friday
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  3. Bela Szabo
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  4. Eugene Patterson
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  5. Etienne M. Aliot
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  6. Ralph Lazzara
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Editors and Affiliations

  1. Department of Cardiology, Hôpital Central, Nancy, France

    Etienne Aliot MD, F.A.C.C. (Professor of cardiology) (Professor of cardiology)

  2. Department of Cardiology, Veterans Administration Medical Center and University of Oklahoma Health Center, Oklahoma City, Oklahoma, USA

    Ralph Lazzara MD, F.A.C.C. (Professor of cardiology) (Professor of cardiology)

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© 1987 Martinus Nijhoff Publishers, Dordrecht

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Jackman, W.M., Friday, K.J., Szabo, B., Patterson, E., Aliot, E.M., Lazzara, R. (1987). Drug-induced torsades de pointes: clinical and experimental observations bearing on mechanism. In: Aliot, E., Lazzara, R. (eds) Ventricular Tachycardias. Developments in Cardiovascular Medicine, vol 71. Springer, Dordrecht. https://doi.org/10.1007/978-94-009-3323-1_12

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  • DOI: https://doi.org/10.1007/978-94-009-3323-1_12

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