Introduction
Torsades de Pointes (TdP) is a rare, life-threatening type of arrhythmia. Arrhythmias is a condition that affects the rhythm of the heart and can cause serious complications to one’s health and well-being. This irregular heart rhythm can occur as bradycardia (slow heartbeat), tachycardia (fast heartbeat), or Torsades de Pointes.
Torsades de Pointes is a French term translated from “twisting of peaks” which is seen on the ECG as the twisting of the QRS complexes which separates TdP from other types of arrhythmias. Therefore, it’s no surprise that identifying TdP usually involves spotting key signs such as a fast (rapid) heartbeat, or a prolonged QT interval seen via an ECG. This article will further explore the causes of Torsades de Pointes, signs and symptoms, and possible treatment of Torsades de Pointes. Tests such as ECGs, QT interval measurements, heart monitors, blood tests for electrolytes, and echocardiograms can help identify TdP.
Understanding arrhythmia
Explanation of arrhythmia
The heart is an important organ of the body that helps to pump blood that goes around the body.1 This action is usually controlled by a technique called a conduction system which sends out electrical signals. When there is a problem with the conduction system it means that the heart is beating in an abnormal way and rhythm. This is known as Arrhythmia.
Arrhythmia is a medical condition that affects the heart's rhythm and can have significant implications for one's health and well-being.
Types of arrhythmias
Arrhythmias can affect anyone but it usually happens in older people. The main types of arrhythmias are:
Bradycardia: This is when the heartbeat is slower.
Tachycardia: This is when the heart is beating faster than normal even when you are resting.
Torsades de Pointes (TdP): This is when the heart beats too fast and is quite specific in that it starts from the lower chambers of the heart.
What is Torsades de Pointes (TdP)?
Definition of TdP
What is torsades de pointes? Torsades de Pointes (TdP) is a rare type of fast heartbeat that starts in the lower part of the heart (ventricles).
Does torsades de pointes go away? The symptoms do not usually last long and can go away but they can happen again if what is causing it isn’t corrected immediately. This can then lead to unconsciousness and death if not treated as soon as possible.
How do you recognise torsade de points? Some of the signs of torsades de pointes are mostly seen with:
- a fast heart rate
- an ECG pattern
- a long QT interval2
What happens in Torsades de Pointes
ECG pattern
Torsades de Pointes is named from a French translation meaning “twisting of the points/peaks”. As such a twisting of the heartbeat known as the QRS complexes is noticed on an electrocardiogram (ECG). (An ECG is a simple test that is used to check how your heart is doing)2
Long (prolonged) QT interval
A prolonged QT interval is a condition that is also spotted using an ECG. It can be caused by certain medicines or genetic abnormalities (congenital factors) which can be inherited from the parents to the children.
Fast (rapid) heart rate
What do torsades feel like? A normal heart rate is known to be around 60 to 100 beats per minute (bpm). But with Torsades de Points, you will feel that your heart is beating fast as the heartbeat is usually seen to be between 150 to 300 beats per minute (bpm).
What causes Torsades de Pointes?
Torsades de Pointes can happen at any age, however, if it happens at an early age, this is usually due to genetic abnormalities (congenital long QT syndrome) and if it occurs later in the years it is usually acquired.3,4 Some of the main causes of Torsades de Pointes include:
- Medications such as certain antidepressants, antibiotics, heart medications, etc
- Electrolyte imbalances, that is calcium, potassium, magnesium
- Congenital factors
Risk factors for Torsades de Pointes
Medication-related risks
Although there hasn’t been much evidence to show how common torsades de pointes is, there are certain medications such as antipsychotics (e.g. haloperidol), anti-sickness (e.g. domperidone) and antibiotics (e.g. erythromycin), etc. that are well known to put one at risk of getting it.3
Genetic predisposition
Some people are born with a problem in their genes which increases their risk of getting torsades de pointes e.g. Jervell and Lange-Nielsen syndrome, Romano-Ward syndrome (also known as Long QT syndrome). However, there hasn’t been enough reliable evidence to identify which certain population has a higher risk of getting TdP. But be rest assured that some experts are working to hopefully better understand and address this issue.4
Is Torsades de Pointes serious?
The short answer is, yes. Therefore, it is important to note that if Torsades de Pointes isn’t treated properly and as soon as possible, can lead to further complications such as ventricular fibrillation, which is a life-threatening condition of a very fast heartbeat that can then lead to fainting or even sudden death. Now that we know the serious nature of Torsades de Pointes, ensuring that the condition and cause are quickly diagnosed and treated immediately as well as monitoring are therefore essential.
Diagnosis and monitoring
You must contact your GP if you feel like you might have Torsade de Pointes. The test your doctor will carry out usually includes:
- Electrocardiogram (ECG) which will include a QT interval measurement
- A heart monitor that you can wear at home
- Blood tests that include checking your electrolytes
- Echocardiogram
Management and treatment
How do you manage or treat torsades de pointes? This can depend on what has caused it and the treatment can either be short-term or long-term.5
Short-term management
- Emergency management: This can be an immediate intervention at the A&E department which can include defibrillation and/or antiarrhythmic medications
- Preventive measures: These include:
- Adjusting by reducing or stopping the medications that have probably caused it
- Correcting any electrolyte imbalance
Long-term management
Usually involves a risk assessment:
- Patients with low-risk factors are usually just observed under the care of their doctor without starting any treatment
- Patients with genetic factors or acquired QT interval are started on medications or medical devices that help to slow the heart
Prevention
How can torsade de pointes be prevented? There are certain things you can do to prevent TdP and they include
- Avoiding triggers such as medications known to cause prolonged QT interval
- Your doctor may also recommend preventing electrolyte imbalances in patients who are at risk
- Genetic counseling and screening of people with family history6
It can be scary to experience irregular heartbeats but it's important to know that it can be managed and treated appropriately if it is spotted early. Torsades de Pointes (TdP) is a rare and unique type of arrhythmia, if you're concerned about your heart, it's always a good idea to talk to your GP.
FAQs
How to recognise torsade de pointes
As Torsades de Points can lead to serious complications, it must be detected, diagnosed, and monitored as soon as possible. Tests such as ECGs, QT interval measurements, heart monitors, blood tests for electrolytes, and echocardiograms can help identify Torsades de Points.
What causes TdP
Some things can trigger Torsades de Pointes such as certain type of medications, electrolyte imbalances (e.g., calcium, potassium, magnesium), and genetic abnormalities (congenital factors). Medications like some antidepressants, antibiotics, and heart medications are known culprits, along with genetic disorders, such as the Jervell and Lange-Nielsen syndrome or Romano-Ward syndrome.
Is torsades de pointes serious
Torsades de pointes can lead to serious complications. It's understandable to feel worried about arrhythmias, especially Torsades de Pointes but it is essential to be aware of the causes, symptoms, and risk factors and ensure that you speak to your GP if you feel that you have Torsades de Pointes. This is because, with early diagnosis, proper management, and preventive strategies, people with Torsades de Pointes can receive the best possible outcomes and lead healthier lives.
Does torsades de pointes go away
Overall, preventing Torsades de Pointes includes avoiding the triggers, especially medications associated with prolonged QT intervals, and addressing electrolyte imbalances.
How do you manage or treat torsades de pointes
Long-term management may involve risk assessments to determine the appropriate course of action, such as medication or medical devices to help regulate the heart. People with a family history will usually require genetic counseling and screening.
Summary
Torsades de Points, a rare and life-threatening type of arrhythmias can have serious consequences, including loss of consciousness and even death if left untreated. Identifying Torsades de Pointes involves recognising when your heart is beating faster. Your doctor might also suggest other specific tests like electrocardiogram (ECG) patterns and a test for long (prolonged) QT interval. The term "Torsades de Pointes" itself refers to the twisting of the points/peaks, as seen on an ECG, which distinguishes it from other arrhythmias.
Management and treatment of Torsades de Pointes depend on what has caused it. For example, short-term management such as defibrillation and antiarrhythmic medications can be used for patients seen in the emergency department. Also, preventive ways that focus on stopping the medications that may have caused Torsades de Pointes and/or correcting electrolyte imbalances can be used.
References
- Buckberg, Gerald D., et al. ‘What Is the Heart? Anatomy, Function, Pathophysiology, and Misconceptions’. Journal of Cardiovascular Development and Disease, vol. 5, no. 2, June 2018, p. 33. PubMed Central, https://doi.org/10.3390/jcdd5020033.
- Kahlon SS, Sikandar R, Tejovath S, Nair S, Hassan D, K Patel K, et al. Diagnosing torsades de pointes based on correlation to qt interval: a systematic review. Cureus [Internet]. 2022 Aug 9 [cited 2023 Oct 29]; Available from: https://www.cureus.com/articles/95652-diagnosing-torsades-de-pointes-based-on-correlation-to-qt-interval-a-systematic-review.
- Zeltser D, Justo D, Halkin A, Prokhorov V, Heller K, Viskin S. Torsade de pointes due to noncardiac drugs: most patients have easily identifiable risk factors. Medicine [Internet]. 2003 Jul [cited 2023 Oct 29];82(4):282. Available from: https://journals.lww.com/md-journal/Fulltext/2003/07000/Studies_on_the_Mechanism_of_a_Fatal.00007.aspx.
- Sauer AJ, Newton-Cheh C. Clinical and genetic determinants of torsade de pointes risk. Circulation [Internet]. 2012 Apr 3 [cited 2023 Oct 29];125(13):1684–94. Available from: https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.111.080887.
- Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, et al. 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: Executive summary. Heart Rhythm [Internet]. 2018 Oct [cited 2023 Oct 29];15(10):e190–252. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1547527117312493.
- Drew BJ, Ackerman MJ, Funk M, Gibler WB, Kligfield P, Menon V, et al. Prevention of torsade de pointes in hospital settings. Journal of the American College of Cardiology [Internet]. 2010 Mar [cited 2023 Oct 29];55(9):934–47. Available from: https://linkinghub.elsevier.com/retrieve/pii/S073510971000094X.
