Diagnosis, Differential ; Electrocardiography ; Humans ; Tachycardia, Ventricular ; Torsades de Pointes

Terfenadine is widely used because of nonsedating effect. But It could rarely provoke a potentially lethal ventricular tachyarrhythmia. Recently, we experienced two cases of torsades de pointes(TDP) of occurred after combined use of terfenadine and ketoconazole in usual dose. In one case, 31-yr-old female presented palpitation and recurrent syncope of sudden onset after ingestion of terfenadine 60mg and ketoconzole 200mg 5 times. On attack, ECG showed a polymorphic ventricular tachycardia, and after attack, showed prolongation of QT interval and TU wave changes. Her laboratory findings were not contributory. TDP was controlled with MgSO4 and isoproterenol infusion. Then, QT interval was normalized and no further episode occurred. In the other case, 32-yr-old female presented palpitation and recurrent syncope of sudden onset after ingestion of terfenadine 60mg and ketoconzole 200mg 5 times. ECG showed prolongation of QT interval and TU wave changes. Her laboratory findings were not contributory. TDP was controlled with MgSO4 and isoproterenol infusion. Then, QT interval was normalized and no further episode occurred.
Eating ; Electrocardiography ; Female ; Humans ; Isoproterenol ; Ketoconazole* ; Syncope ; Tachycardia ; Tachycardia, Ventricular ; Terfenadine* ; Torsades de Pointes*

Torsades de pointes (TdP) is a form of polymorphic ventricular tachycardia associated with a prolonged QT interval or increased U wave. It may occur either in the congenital(idiopathic) form or in the aquired form. Although aquired TdP could be found in many clinical settings such as various drugs, bradycardia, or electrolyte imbalance, it is most commonly induced by drugs. The underlying mechanism is though to be the triggered activity arising as a consequence of early afterdepolarization. Phenothiazine has many derivatives that can lead to occur the cardiovascular events including hypotension, syncope, tachycardia and various ECG changes. Chloropromazine is a propylamine derivative of phenothiazine. We report a case of TdP occurred after chloropromazine usual dosage.
Bradycardia ; Chlorpromazine ; Electrocardiography ; Hypotension ; Syncope ; Tachycardia ; Tachycardia, Ventricular ; Torsades de Pointes*

Anesthesiologists are faced with a growing number of patients in need of cardiac pacing with symptoms of increasing complexity. Because intraoperative pacemaker malfunction can lead to sudden death, it is important for the anesthesiologists to possessthe information necessary to evaluate and treat such patients. On the other hand, torsade de pointes, a particular form of life-threatening polymorphic ventricular tachycardia, is known to be elicited in patients with cardiac pacemakers in the setting of abnormally long QT intervals, decreased heart rate and severe electrolyte disturbances, notably hypokalemia. We herein report a case of intraoperative torsade de pointes that was triggered by pacemaker malfunction-induced bradycardia in a patient with a VVI-type cardiac pacemaker, whose serum potassium and magnesium level were low preoperatively. (Korean J Anesthesiol 1999; 37: 164~167)
Bradycardia ; Death, Sudden ; Hand ; Heart Rate ; Humans ; Hypokalemia ; Magnesium ; Potassium ; Tachycardia, Ventricular ; Torsades de Pointes*

Advanced or complete atrioventricular (AV) block is frequently regarded as a cause of informed syncopal attacks even though escape rhythm is maintained. Torsades de pointes (TdP) may be a significant complication of AV block associated with QT prolongation. Maintaining ventricular rate over 70 beats/min is known to be important to normalize QT interval and to reduce the possibility of bradycardia-related TdP recurrence after pacemaker implantation. We report one case of syncopal attacks associated with TdP in a 70 year old female patient with advanced AV block and prolonged QT interval. She was referred to evaluate palpitation and syncope. Advanced AV block and QT interval prolongation were seen with electrocardiography, but junctional escape rhythm was maintained. Syncopal attacks occurred during temporary pacemaker insertion. Multiple episodes of nonsustained polymorphic ventricular tachycardia and TdP related to syncopal attacks were demonstrated by 24-hour Holter monitoring. A permanent pacemaker was implanted and ventricular rate was set over 70 beats/min resulting in no recurrence of TdP and syncope.
Atrioventricular Block* ; Electrocardiography ; Electrocardiography, Ambulatory ; Female ; Humans ; Recurrence ; Syncope* ; Tachycardia, Ventricular ; Torsades de Pointes* ; United Nations

QT prolongation is a serious adverse drug effect, which is associated with an increased risk of Torsade de pointes and sudden death. Many drugs, including both cardiac and non-cardiac drugs, have been reported to cause prolongation of QT interval. Although meperidine has not been considered proarrhythmic, we present a unique case of a 16-year-old boy without an underlying cardiac disease, who developed polymorphic ventricular tachycardia, ventricular fibrillation and QT prolongation after an intravenous meperidine injection. He had no mutation in long QT syndrome genes (KCNQ1, KCNH2, and SCN5A), but single nucleotide polymorphisms were reported, including H558R in SCNA5A and K897T in KCNH2.
Adolescent ; Death, Sudden ; Heart Diseases ; Humans ; Long QT Syndrome ; Meperidine ; Polymorphism, Single Nucleotide ; Tachycardia, Ventricular ; Torsades de Pointes ; Ventricular Fibrillation

Torsade de pointes (TdP) is a form of polymorphic ventricular tachycardia that is associated with prolongation of the QT interval. Although it occurs in many clinical settings, torsade de pointes is most commonly caused by drugs. The second generation antihistamines, including terfenadine and astemizole, have little sedation or other adverse effects on the CNS. They have been used widely to treat various allergic diseases, but it has been reported that overdoses or combinations with antifungal agents or macrolide antibiotics may lead to TdP. We report a case of TdP that occured during com-bination therapy of terfenadine and ketoconazole.
Anti-Bacterial Agents ; Antifungal Agents ; Astemizole ; Histamine H1 Antagonists, Non-Sedating ; Ketoconazole* ; Tachycardia, Ventricular ; Terfenadine* ; Torsades de Pointes*

Torsades de pointes is a polymorphic ventricular tachycardia associated with prolonged QT interval and increased U wave amplitude. It has been found to be induced by various drugs, electrolyte imbalances, and so on, but the mechanism of torsades de pointes has not been completely documented. Two hypotheses, early afterdepolarization and dispersion of repolarization have been known to be the possible mechanism. Terfenadine and astemizole are the antihistamines, known to be one of the etiologic agents of torsades de pointes, and factors associated with increased risk are significant liver disease, drug overdose, and concomitant administration of imidazole and macrolide antimicrobial drugs. There has been only one case reported that torsades de pointes had been induced by first-generation antihistamine, piprinhydrinate. We experienced a case of 43 year old male patient with torsades de pointes induced by first-generation antihistamine, hydroxyzine and treated successfully with drug cessation, MgSO
Adult ; Astemizole ; Drug Overdose ; Histamine Antagonists ; Humans ; Hydroxyzine* ; Isoproterenol ; Liver Diseases ; Male ; Tachycardia, Ventricular ; Terfenadine ; Torsades de Pointes*

Long QT syndrome is a cardiac disorder of repolarization which is characterized by elctrocardiographic abnormalities including prolonged QT interval, T-wave abnormalities and polymorphic ventricular tachycardia known as Torsades de Pointes. Its clinical manifestation are recurrent syncope, seizure, and sudden death. Recently,we experienced Torsades de Pointes(TdP) by head-up tilt test in 24 year-old female patient presenting recurrent syncope and long QT interval. Beta-blocker and left cervicothoracic sympathetic ganglionectomy were not effictive, then we tried mexiletine. After mexiletine medication, the QT interval was significantly shortened and there was no more syncope.
Death, Sudden ; Female ; Ganglionectomy ; Humans ; Long QT Syndrome* ; Mexiletine ; Seizures ; Syncope ; Tachycardia, Ventricular ; Torsades de Pointes* ; Young Adult

Torsades de pointes, a polymorphic ventricular tachycardia associated with prolonged QT interval, is a well-known life-threatening arrhythmia, which has been found to be induced by various causes such as drugs, electrolyte imbalances, and severe bradycardia. Cisapride is a gastrointestinal prokinetic drug, which is widely used to treat gastroesophageal reflux disease or other functional gastrointestinal disorders. Cisapride can cause torsades de pointes and cases of torsedes de pointes induced by cisapride have been reported in other countries. Cases of torsades de pointes associated with antihistamine drugs have been reported in Korea, however, cisapride-induced torsades de pointes case has not been reported. We report a case of 31 year-old female patient who experienced repeated loss of consciousness due to cisapride-induced torsades de pointes.
Adult ; Arrhythmias, Cardiac ; Bradycardia ; Cisapride* ; Female ; Gastroesophageal Reflux ; Gastrointestinal Diseases ; Humans ; Korea ; Tachycardia, Ventricular ; Torsades de Pointes* ; Unconsciousness