Torsades de pointes, a quarter of a century later: a tribute to Dr. F. Dessertenne

Autor: Philippe Coumel, Alexandre Fabiato
Rok vydání: 1991
Předmět:
Zdroj: Cardiovascular drugs and therapy. 5(1)
ISSN: 0920-3206
Popis: Twenty-five years ago, in 1966, Dr. Franqois Dessertenne opened a new chapter of electrocardiography with two papers on the torsades de pointes [1,2]. A translation of the first [1] has appeared in Cardiovascular Drugs and Therapy. The second [2], translated in this issue, is much more complete and bet ter illustrates the uniqueness of Dr. Dessertenne's contribution. Dr. Dessertenne was, and still is, a practicing clinician. He did no animal experimentation or even electrophysiologic exploration during cardiac catheterization. His only approach was to observe electrocardiograms and vectocardiograms, but he did this so meticulously that he made important discoveries and became a highly respected scientist. His goal was not to demonstrate a cellular mechanism for arrhythmias, but to provide the descriptive basis that should permit experimentalists to investigate mechanisms. Thus, his suggestion in the first paper [1], that the torsades de pointes were generated by two alternating ectopic foci, was out of character. He removed any suggestion of mechanism in the second paper [2], focusing his at tention on a meticulous description of what he appropriately te rmed "a new chapter of electrocardiography." This new chapter includes the description of not only the torsades de pointes, but also the ventricular fibrillation, on which Dr. Dessertenne had previously wri t ten several articles (e.g., ref. 3) including an entire issue of the Actualit~s Cardiologiques et Ang~iologiques Internationales [4]. Not a single word of this electrocardiographic description can be deleted. I t is a jewel of precision and of elegant French writing, which is difficult to translate accurately into English. Although most English-speaking cardiologists know the te rm torsades de pointes, few fully understand its meaning. They will certainly be grateful to Professor Opie for publishing the translation of Dr. Dessertenne's major article on this subject [2]. When Dr. Dessertenne coined the term, torsades de pointes, he referred his collaborators to the Robert Dictionary, which was still recent . Mrs. Dessertenne had just given the six volumes of this dictionary to her husband. In the Robert Dictionary, torsade is defined as: a) a bundle of threads twisted in a helix (or spiral) for ornamental purposes, b) long hair twisted together. But it was the third definition, referr ing to architecture, that a t t racted Dr. Dessertenne 's attention: ornamental motive imitating twisted hairs or threads as often seen on classical architectural columns. To him, this was the best analogy to the electrocardiographic tracing that he was describing. To fur ther demonstrate what he meant by pointes, he used one of Mrs. Dessertenne's combs with pointed tee th separated by broader gaps. He held one end of this comb still and rotated the other end along the long axis of the comb. The relative rigidity of the comb stopped the rotation before 180 ~ A 180 ~ rotation would have been needed to fully demonstrate how the points of these tee th and the intermediary gap simulated, respectively, the pointed side and the broad side of the asymmetrical electrographic waves that formed the torsades de pointes. Dr. Dessertenne never ignored that similar tracings had been published by the group of Dr. Sidney Schwartz. He quoted one of Dr. Schwartz's major articles [5]. More references to the work by Dr. Schwartz can be found in the excellent section on this subject in the book by Cranefield and Aronson [6]. Yet, Dr. Schwartz had not individualized this arrhythmia. This individualization with a meticulous description is the merit of Dr. Dessertenne. Although Dr. Desser tenne carefully refrained in his major article [2] from any implication on the mechanism of this arrhythmia, he was ve ry interested in this mechanism and suggested a number of experimentally testable ideas. He was somewhat in teres ted
Databáze: OpenAIRE
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