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Editor's Correspondence
July 27, 1998

Torsade or Not Torsade? That Is the Question

Arch Intern Med. 1998;158(14):1578-1579. doi:

I am concerned about the case report by Jackson et al1 of the patient who was diagnosed as having torsade de pointes while receiving a low dose of haloperidol. There are several statements in the report that I find are not supported by the data presented.

Torsade de pointes is a syndrome and not solely an electrocardiographic pattern. It is seen in patients with abnormal repolarization that is usually but not always manifested by a prolonged QT interval. The classic precipitant of torsade de pointes is a long-short cycle coupling interval that further alters repolarization. Patients with the condition usually present with episodes of loss of consciousness that self-terminate but can occasionally proceed to cardiac arrest. A careful distinction must be made between torsade de pointes and polymorphic ventricular tachycardia secondary to ischemia, since their treatments are completely different.

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