ECG rhythms Ventricular and arrest rhythms
Torsades de pointes ECG
Torsades de pointes. Fast, wide, polymorphic complexes whose amplitude rises and falls around the baseline, after a long QT.
A 30-second recording of the heart model, played in real time. Run live starts the engine itself with this rhythm.
Computed by the TracingsMD heart model (Junkers engine): simulated for education, not a patient recording and not for diagnosis.
Measured on this recording
| Ventricular rate | 220/min |
|---|---|
| PR | Not assessable in this rhythm |
| QRS | 156 ms |
| QT | Not assessable in this rhythm |
| QTc (Bazett) | Not assessable in this rhythm |
| QTc (Fridericia) | Not assessable in this rhythm |
What it is
A polymorphic ventricular tachycardia that occurs with a long QT: the QRS complexes twist around the baseline as their axis and amplitude change. It often starts after a short–long–short RR sequence and can degenerate into ventricular fibrillation. This recording shows a sustained run; the long QT that precedes it is shown on the Prolonged QT interval page.
How to read this strip
| Rate | Very fast. |
|---|---|
| Rhythm | Irregular, spindle-shaped bursts. |
| P waves | Not identifiable. |
| PR | None. |
| QRS | Wide, changing height and axis. |
| QT | Not measurable now; long before the event. |
Causes
- A long QT from drugs, low potassium or magnesium, bradycardia or pauses.
- Congenital long QT syndromes.
What to consider
- Pulseless or unstable sustained torsades is treated like ventricular fibrillation: unsynchronized defibrillation.
- Intravenous magnesium is first-line, even when the magnesium level is normal.
- Stop QT-prolonging drugs and keep potassium high-normal (4.5–5.0 mmol/L); for recurrent pause-dependent torsades, raising the heart rate with temporary pacing (or isoproterenol, avoided in congenital long QT and ischemia) helps prevent recurrence.
- Antiarrhythmic drugs that prolong the QT can make it worse.
Key point
Torsades grows from a long QT: shock it when pulseless, give magnesium, and stop the QT-prolonging drugs that started it.
Not to be confused with
- Monomorphic ventricular tachycardia — In monomorphic VT every QRS looks the same. Here the height and axis twist around the baseline.
- Ventricular fibrillation — VF has no identifiable QRS complexes. Here discrete wide complexes wax and wane in a spindle pattern.
- Sinus rhythm with artifact — With artifact, regular narrow QRS complexes keep marching through the noise. Here the complexes themselves are wide and twist, and the patient is pulseless.