[Risk management with regard to QT-prolonging drugs]. / Risicomanagement rond QT-verlengende geneesmiddelen.

Drug-induced QT prolongation increases the risk of Torsade de Pointes (TdP). Drug-induced QT prolongation is a complex and unpredictable system due to many uncertainties. Risk factors such as electrolyte disturbances, heart failure and genetics play an important role in estimating the effect on QT prolongation. Moreover, the degree of QT prolongation is not always directly related to the risk of TdP and the assessment of the QT-interval is variable depending on the type and timing of QT measurement. Therefore, the variation in QT measurement may be larger than the effect of certain drugs on the QT interval. Because of the potentially lethal risk, several measures are undertaken to reduce the risk of QT prolongation and TdP, while their effect and proportionality are unclear. We suggest we should be less stringent in certain settings when risk of TdP is extremely low given the limited availability of our resources.

Torsade de pointes en el manejo de una fibrilación auricular / Torsade de pointes in the management of atrial fibrillation

La torsade de pointes es una causa frecuente de muerte súbita de origen cardiaco con mecanismos electrofisiológicos inciertos y orígenes bien diversos. Presentamos el caso de un paciente con un cuadro bronquial en tratamiento farmacológico con macrólidos que presenta, en el contexto de una fibrilación auricular, un episodio de torsade de pointes autolimitado que cede de forma espontánea sin sintomatología asociada (AU)

Torsade de pointes is a frequent cause of sudden death of cardiac origin, with uncertain mechanisms of actions and very diverse origins. A case is presented of a patient with a bronchial condition on pharmacological treatment with macrolides, and who, as well as having atrial fibrillation, suffered an episode of self-limiting torsade de pointes that abated spontaneously with no associated clinical complications (AU)

El marcapasos en la Torsade de Pointes: ¿un arma terapéutica o etiológica? / The pacemaker implantation in the Torsade de Pointes: a therapeutic or ethiologic weapon?

La torsade de pointes (TdP) es una causa frecuente de muerte súbita de origen cardiaco, sin embargo, su electrofisiología y tratamiento no están todavía claramente establecidos. Comunicamos el caso de una paciente portadora de marcapasos que presentó varios episodios de taquicardia helicoidal o TdP, que fueron eficazmente corregidos con sobreestimulación cardiaca de su marcapasos y sulfato de magnesio iv. La causa de la prolongación del QT y el inicio de esta arritmia pudo estar favorecido por la estimulación epicárdica de su marcapasos. Queremos incidir en la sobreestimulación cardiaca como tratamiento eficaz de la TdP, y en la necesidad de valorar el riesgobeneficio en la implantación de determinados tipos de marcapasos en pacientes con riesgo de prolongación del intervalo QT y muerte súbita secundaria a TdP (AU)

The Torsade de pointes (TdP) is a frequent cause of sudden death of cardiac origin, however, its electrophysiology and treatment are not still clearly established. We communicate a case of a patient with pacemaker implantation that presented various episodes of Torsade of Pointes (TdP) those were efficiently corrected with overdrive pacing and sulphate of magnesium iv. The cause of the prolonged QT interval and the start of this arrhythmia could be favored by the stimulation in epicardium of its pacemaker. We want to impact in the overdrive pacing as efficient treatment of the TdP, and we must value the risk-benefit in the establishment of determined pacemaker’s types in patients at the risk of prolonged QT interval and secondary sudden death by TdP (AU)

Haloperidol por vía intravenosa y torsade de pointes / Torsade de pointes associated with intravenous haloperidol

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