All iLive content is medically reviewed or fact checked to ensure as much factual accuracy as possible.
We have strict sourcing guidelines and only link to reputable media sites, academic research institutions and, whenever possible, medically peer reviewed studies. Note that the numbers in parentheses ([1], [2], etc.) are clickable links to these studies.
If you feel that any of our content is inaccurate, out-of-date, or otherwise questionable, please select it and press Ctrl + Enter.
Pirouette-type ventricular tachycardia: causes, symptoms, diagnosis, treatment
Medical expert of the article
Last reviewed: 04.07.2025
Ventricular tachycardia of the "pirouette" type is a special form of polymorphic ventricular tachycardia in patients with an extended interval. It is characterized by frequent, irregular QRS complexes that seem to "dance" around the isoline on the electrocardiogram. This tachycardia may stop spontaneously or transform into ventricular fibrillation. It is accompanied by severe hemodynamic disorders and often death. Treatment includes intravenous magnesium, measures aimed at shortening the QT interval, and unsynchronized cardioversion when ventricular fibrillation develops.
Prolongation of the interval leading to the development of tachycardia of the "pirouette" type can be natural or drug-induced.
Two hereditary syndromes of long PQ interval have been identified: Jervell-Lange-Nielsen syndrome (autosomal recessive inheritance, associated with deafness) and Romano-Ward syndrome (autosomal dominant, without deafness). At the same time, at least six variants of long PQ syndrome are known, which arise as a result of a defect in the genes encoding specific transmembrane potassium or sodium channels.
Most often, torsades de pointes is the result of medications, usually class Ia, Ic, and III antiarrhythmic drugs. Other drugs include tricyclic antidepressants, phenothiazines, and some antiviral and antifungal drugs.
Prolongation of the interval leads to the development of arrhythmias due to prolongation of repolarization, which induces early postdepolarization and a wide distribution of refractoriness zones.
Symptoms of ventricular tachycardia of the "pirouette" type
Patients often complain of syncope, since the existing number of contractions (200-250 per minute) does not provide the necessary blood supply. Patients who are conscious note palpitations. Sometimes prolongation of the QT interval is diagnosed after the rhythm is restored.
Where does it hurt?
What's bothering you?
Diagnosis of ventricular tachycardia of the "pirouette" type
The diagnosis is established based on ECG data: wave-like changing peaks of QRS complexes, the complexes change their direction around the isoline (Fig. 75-18). The electrocardiogram between attacks demonstrates an extended QT interval, corrected for the heart rate (QT). Normal values vary within 0.44 s, they differ significantly in different people and depending on gender. Family history may indicate a hereditary syndrome.
[ 1 ]
What do need to examine?
How to examine?
Treatment of ventricular tachycardia of the "pirouette" type
An acute attack usually lasts for a long time and causes hemodynamic disturbances. It is eliminated by unsynchronized cardioversion, starting with 100 J. However, as a rule, the attack quickly recurs. Patients are often sensitive to magnesium preparations: magnesium sulfate at a dose of 2 g intravenously for 1-2 min. If this treatment is ineffective, a second bolus administration is carried out after 5-10 min. In patients without renal failure, an infusion at a dose of 3-20 mg / min can be started. Lidocaine (class lb) shortens the QT interval and can be effective mainly in the drug-induced tachycardia of the "pirouette" type, la, Ic and III classes of antiarrhythmic drugs are prohibited.
If medications are the cause of torsades de pointes, they should be stopped, but until the drug is eliminated, patients with frequent or prolonged episodes of torsades de pointes should receive drugs that shorten the QT interval. Because an increase in heart rate shortens the PQ interval, temporary pacing, intravenous isoproterenol, or a combination of these methods is often effective. Long-term therapy is necessary for patients with congenital long PQ syndrome. Treatment consists of beta-blockers, permanent pacing, ICDF, or a combination of these. Family members should be examined with an ECG.