Torsades de Pointe Menaçantes Compliquant un Bloc Auriculo-Ventriculaire Complet

Mamadou Diakité, Abdoulaye Kanté, Souleymane Coulibaly, Boureima Dembele, Alou Sangaré, Mariam Sacko, Samba Sidibe, Nouhoun Diallo, Abdoul Karim Sacko, Oumar Samassekou, Alou Diarra, Ilo Bella Diall

Abstract


RÉSUMÉ
Les torsades de pointe (TdP) sont une complication immédiatement létale des blocs auriculo-ventriculaires (BAV). Il s’agit d’une tachycardie ventriculaire polymorphe qui est caractérisée sur le plan électrocardiographique par un QT long, des ventriculogrammes élargis et fluctuants de fréquence élevée (200-250/min), succédant à une extrasystole ventriculaire initiatrice ; sur le plan clinique par une inefficacité cardio-circulatoire lorsqu'elles se prolongent, à l'origine de lipothymies ou syncopes. Exceptionnellement les épisodes de TdP peuvent évoluer vers la mort subite. Nous rapportons le cas d’une patiente âgée de 55 ans, ayant présenté un BAV complet mal toléré compliqué d’arrêt cardiaque ressuscité en rapport avec des accès de TdP, pour lesquels aucune étiologie apparente ni cardiopathie structurelle n’ont pu être identifiées. La prise en charge malgré les difficultés inhérentes à notre système de soins, a toutefois pu se solder par l’implantation d’un stimulateur cardiaque double chambre. L’enquête génétique est en cours.

ABSTRACT
Torsades de pointe (TdP) is an immediately life-threatening complication of atrio-ventricular block (AVB). It is defined as a polymorphic ventricular tachycardia which is characterized on ECG by a baseline long QT, enlarged and fluctuating high rate ventriculograms (200-250 beats per min), usually initiated by ventricular premature contraction.  Clinical possible consequences maybe cardio-circulatory inefficiency when they are prolonged, causing faintness or syncope. Exceptionally, episodes of TdP can lead to sudden death. We report the case of a 55-years-old female patient, who presented complete AVB with resuscitated cardiac arrests episodes due to TdP attacks. The initial cardiac evaluation excluded any structural heart disease. Isoproterenol infusion avoided any recurrence of TdP. Despite main difficulties related to our health care system, the patient could be implanted with a dual-chamber pacemaker. The genetic testing is ongoing.

Keywords


Bloc auriculo-ventriculaire complet ; Electrocardiogramme ; Torsades de pointe.

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