How to Treat Torsades De Pointes?

Things to note:

• Cardioversion/defibrillation, as necessary.
• Torsades complicating bradycardia: temporary pacing.

Medical Treatment:

• Stop all QT-prolonging drugs.
• Correct serum potassium
• Magnesium sulphate, IV, 2 g administered over 5-10 minutes.

If recurrent episodes after initial dose of magnesium sulphate:

• Magnesium sulphate, IV, 2 g administered over 24 hours.

Torsades complicating bradycardia:

• Adrenaline infusion to raise heart rate to > 100/ minute (if temporary pacing unavailable).

When to refer:

• All cases of wide QRS tachycardia, after resuscitation and stabilization.