Torsades de Pointes

Prolonged  Q-T Syndrome

  

Treatments for Torsades Patients

 

Treatment & maintenance for Torsades:

Prompt implantation of an AICD Defibrillator/pacemaker by a competent electrophysiologist with Torsades experience is a necessary treatment as well as a sudden cardiac death preventative measure. St Jude has one of the most reliable AICDís for Torsades and prolonged Q-T patients.

Electrophysiologists should follow the same guidelines listed above for Surgeons and anesthesiologists. Torsades patients AICD surgeries should not be performed outside of a hospital setting due to the issues with sterile requirements and inability to use common antibiotics.

Electrophysiologists who are not fully experienced with Torsades, often fail to set the AICD minimum heart pacing rate to match the expected equivalent average resting heart rate levels appropriate to the gender, age and patient specifics. By overlooking the Torsades patientís potential for prolonged Q-T and heart rate drop, the AICD is often left at the default or low setting such as 50 BPM. Subsequently, the Torsades patient can experience frequent dizziness, nausea & syncope from the fluctuating heart rate levels. (as an example: I am a female Torsades patient with a St Jude AICD. A less experienced electrophysiologist had left my AICD defaulted to 50 BPM, which caused syncope (fainting) & vertigo as my heart rate fluctuated up and down. My current electrophysiologist with extensive Torsades & prolonged Q-T experience corrected my AICD minimum heart rate pace setting to 75 bpm.)

When setting the AICD upper heart rate shock level, keep in mind the heart rate levels generated during cardiac diagnostic nuclear stress tests. You would not want your patient to receive a defibrillator shock during a standard treadmill test or impair the heart rate levels required to conduct a thorough nuclear stress test diagnostic.

Be sure to verbally discuss the doís and doníts for post implant surgery patients and ongoing precautions. Provide a written list for the patients reference as well but donít depend on the patient to read the instructions.

The Torsades patient with an AICD should be seen by the electrophysiologist no less than every 6 months or more frequently as appropriate to the stability of their condition. Be sure to print out a record of the histories, settings and events stored in the AICD during each visit. Evaluation of the AICD readings, events & records should be performed by the Electrophysiologist, not an assistant. Additional home monitoring & reporting, portable Fib and heart loop monitors and other devices are always options to supplement the patientís care.

 

 

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