First10EM - Justin Morgenstern - January 9, 2017
"Torsades de pointes is a ventricular tachycardia. In the unstable patient, cardiovert. In the pulseless, defibrillate. (The polymorphic nature of the rhythm may interfere with the defibrillator’s ability to synchronize, so cardioversion may not be possible. In that case, in the unstable patient, deliver an unsynchronized shock.)
What do you do if the patient is stable? I think it is reasonable to electrically cardiovert stable ventricular tachycardia, but you can also attempt to treat it medically. Torsades de pointes is caused by a prolonged QT. Almost all of the antiarrhythmics that we normally use to treat ventricular tachycardia, such as amiodarone and procainamide, will prolong the QT further, and therefore can make your patient worse. Do not give amiodarone or procainamide. The medical treatment for stable torsades de pointes is magnesium..."