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Review
. 2012 Apr 3;125(13):1684-94.
doi: 10.1161/CIRCULATIONAHA.111.080887.

Clinical and genetic determinants of torsade de pointes risk

Andrew J Sauer  1 , Christopher Newton-Cheh
Affiliations
Review

Clinical and genetic determinants of torsade de pointes risk

Andrew J Sauer et al. Circulation. .
No abstract available

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Figures

Figure 1
Figure 1. Telemetry strips demonstrating an example of torsade de pointes
In both strips the top tracing represents lead II, the middle tracing lead V1, and the bottom tracing an arterial line waveform at the time of the arrhythmia. The stereotyped pattern of TdP is observed in which premature ventricular complexes, possibly due to early after depolarizations, are followed by long R-R intervals setting up the short-long-short sequence that triggers polymorphic ventricular tachycardia. The arterial line confirms a pulseless cardiac arrest. The second rhythm strip shows the classic twisting morphology of the ventricular tachycardia which degenerates into ventricular fibrillation.
Figure 2
Figure 2. Transmural dispersion of repolarization
Shown here are the sotalol-induced changes in action potential duration of each layer of the canine left ventricular arterially perfused wedge. Note the disproportionately prolonged M-cell action potential and its corresponding contribution to the prolongation of the time from the peak to the end of the T wave (Tpeak-end). Adapted from Circulation, Yan et al: Cellular basis for the normal T wave and the electrocardiographic manifestations of the long-QT syndrome, pages 1928-1936, Copyright 1998, with permission from Wolters Kluwer Health.
Figure 3
Figure 3. Triangulation
Shown are monophasic action potentials before (blue) and after (pink) exposure to a HERG-binding agent (rapidly inward-rectifying potassium channel blockade), demonstrating the triangular shaped action potential with prolonged duration (ms). Adapted from Circulation, Hondeghem et al: Instability and triangulation of the action potential predict serious proarrhythmia, but action potential duration prolongation is antiarrhythmic, pages 2004-2013, Copyright 2001, with permission from Wolters Kluwer Health.
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