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.

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