(Circulation. 1999;100:1462.)
© 1999 American Heart Association, Inc.
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As Americans, We Should Get This Right
Diplomate, ACVIM (Cardiology and Internal Medicine) Professor of Medicine, Section of Cardiology, Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York
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To the Editor:
After reading just a fraction of the many articles published on the long-QT syndrome, I became confused about the correct spelling of the distinctive polymorphic ventricular tachycardia identified in this disease. I have seen the following spellings: torsade de pointe, torsades de pointe, torsades de pointes, and torsade de pointes. In the November 24, 1998, issue of Circulation, in the wonderful article by Drs Shimizu and Antzelevitch,1 the term "torsade de pointes" was used. In search of the correct way to spell this disorder, I consulted with French medical colleagues. They have informed me that "torsades de pointes" is the right way. The English language dominates so much of medical writings and is usually the presiding language at scientific meetings around the world. It sure seems to me that we could at least get this one, frequently used phrase consistently correct. We owe it to the very beautiful French language. TORSADES DE POINTES.
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1. Shimizu W, Antzelevitch C. Cellular basis for the ECG features of the LQT1 form of the long-QT syndrome: effects of ß-adrenergic agonists and antagonists and sodium channel blockers on transmural dispersion of repolarization and torsade de pointes. Circulation. 1998;98:2314–2322.
Response
Masonic Medical Research Laboratory, Utica, NY
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We are grateful to Dr Sydney Moise for her kind remarks regarding our recent article in Circulation.1
The spelling of "torsade(s) de pointes" has received a good deal of attention over the years, yet both "torsade de pointes" and "torsades de pointes" continue to be widely used to describe the atypical polymorphic ventricular tachycardia that commonly accompanies the long-QT syndrome (LQTS). A scan of the literature reveals that even among French cardiologists and electrophysiologists, both terms are widely used.2 3
To gain an appreciation for why this is, it behooves us to go back to the origin of the term as described by Dessertenne.4 5 Because of the sinusoidal twisting of the QRS around the isoelectric line, Dessertenne termed this arrhythmia "torsade de pointes," or twisting of the points. It would appear that Dessertenne and many prominent French electrophysiologists who subsequently published on the subject2 considered a single twisting of the points as a "torsade de pointes" and repeated twistings or repeated episodes as "torsades de pointes."
Thereupon rests the distinction. The unit cycle that defines the arrhythmia is a "torsade," whereas repeated twisting or repeated episodes are "torsades." Because a single twisting of the QRS around the isoelectric line is sufficient to define the arrhythmia under congenital or acquired long-QT conditions, "torsade de pointes" should suffice to describe the tachycardia entity. Although repeated twisting of the points during a single episode may be more accurately depicted as "torsades de pointes," this term does not accurately describe a single twisting of the points, frequently observed in clinical cases as well as in experimental models of LQTS. It can be further argued that repeated episodes of torsade(s) de pointes should not be noted in the plural, because in the English language they are not referred to as atypical polymorphic ventricular "tachycardias" but rather as episodes or runs of "tachycardia." This distinction is due largely to fundamental differences in grammar usage between the 2 languages.
In summary, from our vantage point and with all due respect for the French language, "torsade de pointes," because it defines the arrhythmia and is all encompassing, might best be used to denote the arrhythmia entity (whether comprised of single or repeated episodes). In documents written in English, "torsades de pointes" might best be reserved for describing repeated twistings during a single episode.
While our intent at the outset was to attempt to arrive at a universally acceptable spelling for torsade de pointes, we suspect that we may have contributed to a further muddying of the water, or is it "waters"? Wasn't it the French who coined the term "vive la difference?"
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1. Shimizu W, Antzelevitch C. Cellular basis for the electrocardiographic features of the LQT1 form of the long-QT syndrome: effects of ß-adrenergic agonists and antagonists and sodium channel blockers on transmural dispersion of repolarization and torsade de pointes. Circulation. 1998;98:2314–2322.
2. Leenhardt A, Coumel P, Slama R. Torsades de pointes. J Cardiovasc Electrophysiol. 1992;3:281–292.
3. Locati EH, Maison-Blanche P, Dejode P, Cauchemez B, Coumel P. Spontaneous sequences of onset of torsade de pointes in patients with acquired prolonged repolarization: quantitative analysis of Holter recordings. J Am Coll Cardiol. 1995;25:1564–1575.[Abstract]
4. Dessertenne F. La tachycardie ventriculaire a deux foyers opposes variables. Arch Mal Coeur. 1966;59:263–272.
5. Dessertenne F, Gourgon R, Coumel P, Fabiato A. Tachycardie ventriculaire et "torsades de pointes." Ann Cardiol Angeiol (Paris). 1971;20:243–251.[Medline] [Order article via Infotrieve]
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