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Patient
48-year-old man with history of inferior infarction; hospitalization following the occurrence of 2 episodes of traumatic syncope; recording of this tracing;
Trace
On these Holter tracings, we find the different elements of torsade de pointes:
1) a long QT on the sinus rhythm;
2) minimally premature ventricular extrasystoles but falling on the T wave because of its prolonged duration; extrasystoles in couplets or bursts;
3) onset of a tachycardia on a ventricular extrasystole; wide QRS tachycardia between 170 and 200 bpm; polymorphic irregular tachycardia with rotation of QRS complexes around the "isoelectric" baseline with change of axis (positive QRS, then negative, then positive) approximately every 20 ventricular complexes;
4) a spontaneous termination of the episode explaining the occurrence of a syncope and not of a sudden death;
Exergue
A torsade of points corresponds to an irregular, polymorphic wide QRS tachycardia with a characteristic twisting pattern around the baseline, most often spontaneously resolving and occurring in a setting of long QT and bradycardia.
Torsade de pointes corresponds to a tachycardia with intermediate properaties positioned between ventricular fibrillation and ventricular tachycardia with a characteristic clinical and electrocardiographic presentation: