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Ventricular Tachycardia: Torsades des Pointes


Torsades des pointes means "twisting of the points" and describes the appearance of the above pattern, a type of ventricular tachycardia.  Notice the waxing and waning of amplitude, best seen in lead II. The electrical axis - the direction the wave of depolarization takes through the ventricles - is rotating within the ventricular mass.   Notice that there is a dual chamber electronic pacemaker firing here, and that something odd happens about the time of the third set of pacer spikes.  Did the pacing stimulus evoke this untoward response?  Possibly.  A stimulus is applied to the ventricles during what is apparently a native beat, and the dysrhythmia begins, being a kind of R-on-T phenomenon.  Torsades is typically associated with a prolonged Q-T interval, and some drugs typically used to treat V-tach worsen torsades, rather than helping.