Helicoid ventricular tachycardia, torsade de pointes, in acute myocardial infarction

Helicoidal ventricular tachycardia (Torsades de Pointe), (HVT) is an arrhythmia with peculiar characteristics and therefore should be individualized. The occurrence of HVT during acute myocardial evolution has been denied by many authors. In this paper, the possibility that this association may be not only coincidental is analyzed. A group of 1,307 patients with acute myocardial infarction was studied, in 29 of them this arrhythmia was detected in the first 72 hours and these patients didn't have an associated disease and/or treatment related to HVT. This represents an incidence of 2.22% in this group. The helicoidal ventricular tachycardia had a peculiar behavior, different to the one found in HVT of other etiologies. It was triggered by early premature ventricular beats, it was found even in cases with supraventricular tachycardia and acute atrio--ventricular heart block, very seldom is autolimited and usually degenerates into ventricular fibrillation, the most important factor in association with this arrhythmia is QT prolongation. Intracavitary pacing is the treatment of choice.