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  • Title: [Torsades de pointes with short coupling interval].
    Author: Leenhardt A, Glaser E, Burguera M, Nürnberg M, Maison-Blanche P, Coumel P.
    Journal: Arch Mal Coeur Vaiss; 1993 May; 86(5 Suppl):777-82. PubMed ID: 8267506.
    Abstract:
    The authors describe a ventricular arrhythmia observed in 14 patients between 1972 and 1991, and 9 cases in the literature. The patients were hospitalised for investigations of syncope related to torsades de pointes. They were characterised by the very short coupling interval to the initiating extrasystole (average: 245 ms), by the young age of the patients (average: 34.6 years) and by the absence of overt cardiac disease. The resting electrocardiogrammes were normal, especially ventricular repolarisation. Some recordings showed isolated ventricular extrasystoles with short coupling intervals. Quite often, a family history of sudden death was obtained. These episodes of ventricular arrhythmia may degenerate to ventricular fibrillation. Pharmacological and electrophysiological investigations did not show any consistent characteristic electrophysiological behaviour. Investigations of autonomic nervous system function showed a decrease in global sinus rhythm variability and an increased sympathetic over parasympathetic activity. The clinical outcome of these patients is unpredictable with present methods. From a therapeutic point of view, Class I antiarrhythmics, betablockers and amiodarone were ineffective. Verapamil showed an electrocardiographic improvement by increasing the coupling interval of the extrasystoles and decreasing or even suppressing some repetitive forms, but without preventing recurrences. The indications for an implantable automatic defibrillator should be considered in this group of patients. These patients have clinical and electrocardiographic abnormalities which are sufficiently coherent for them to constitute a new pathological entity which the authors suggest calling "torsades de pointes with a short coupling interval".
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