From the Guidelines
Magnesium sulfate is the first-line antiarrhythmic medication for pediatric torsades de pointes (TdP) arrest after return of spontaneous circulation (ROSC). The recommended dose is 25 to 50 mg/kg IV, with a maximum single dose of 2 g, administered as a rapid infusion over several minutes 1. This treatment approach is based on the 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care, which emphasizes the importance of prompt magnesium sulfate administration in the management of TdP 1. Key aspects of management include:
- Initiating CPR and defibrillation when pulseless arrest develops
- Administering magnesium sulfate as a rapid IV infusion
- Correcting underlying electrolyte abnormalities, such as hypokalemia and hypomagnesemia
- Avoiding QT-prolonging medications that can worsen TdP
- Considering temporary overdrive pacing in cases of refractory TdP
- Initiating beta-blocker therapy, such as propranolol, in patients with congenital long QT syndrome once the acute episode is resolved.
From the Research
Antiarrhythmic Treatment for Pediatric Torsades de Pointes
- The use of magnesium sulfate (MgSO4) is supported by several studies as an effective treatment for torsades de pointes (TdP) in pediatric patients 2, 3, 4, 5.
- In a case report of a 4-month-old infant with TdP secondary to procainamide treatment, intravenous magnesium was administered, and the TdP resolved after one bolus of magnesium sulfate 3.
- The treatment of TdP with magnesium sulfate has been shown to be effective in abolishing the arrhythmia and preventing its recurrence, with no significant changes in the QT interval observed after treatment 2, 4.
- Magnesium sulfate is considered a safe and effective treatment for TdP, and its use is recommended as the first line of therapy for this arrhythmia 4, 5.
- Other treatments for TdP, such as isoproterenol infusion, cardiac pacing, and intravenous atropine, may also be effective, but magnesium sulfate is generally considered the treatment of choice 6, 5.