Perioperative Torsade de Pointes Ventricular Tachycardia

To the Editor: We read with interest the case report by Soroker et al. [1] concerning perioperative occurrence of torsade de pointes ventricular tachycardia (TdPVT). We wish to add three important ideas to their excellent work. First, we want to insist on the fundamental relation linking heart rate and QT interval. Slower will be the heart rate, longer will be the QT interval. All perioperative bradycardic factors will facilitate long QT-induced arrhythmia occurrence [2]. This would be of major concern when performing epidural anesthesia. Inversely, any bradycardia prevention by drug therapy or cardiac pacing would be highly protective. Second, one characteristic of TdPVT is its frequent spontaneous reversal [3]. This particularity may be helpful in differentiating some unusual forms of TdPVT from true ventricular fibrillation and making the best therapeutic choices. Third, we wish to add to the causes of the acquired long QT syndrome the perioperative use of Bepridil [4]. Bepridil is a combined calcium-sodium blocker having antianginal and antiarrythmic properties. Because of its strong QT prolongation effect, Bepridil is actually withdrawn from U.S. market, but is unfortunately still used in Europe in some indications of refractory angina. Perioperative use of this drug merits undoubtedly close attention. S. Broka, MD A. Ducart, MD E. Collard, MD L. De Roy, MD V. Delire, MD A. Mayne, MD P. Randour, MD K. Joucken, MD Departments of Anesthesiology and Cardiology, University Clinics UCL of Mont-Godinne, B-5330 Yvoir, Belgium