Late onset, prolonged asystole following organophosphate poisoning: a case report

Organophosphate (OP) compounds are commonly used as suicidal agents and produce characteristic toxic effects. Cardiac arrhythmias are often observed in the acute phase of toxicity; late onset polymorphic ventricular tachycardia preceded by prolonged QT interval on the EKG is also known to occur. However, there are no reports of late onset, prolonged asystole without preceding arrhythmias and after acute toxicity had abated.

We report a case of prolonged asystole 12 days after ingestion of an OP compound, after apparent recovery from the acute toxic effects. Asystole persisted for 25 min, followed by successful resuscitation without any sequelae.

Although cardiac arrhythmias and circulatory arrest are known to occur following OP ingestion, these are often in the acute phase of toxicity. Our patient had no preceding cardiac manifestations but developed prolonged refractory asystole after 12 days of ingestion of the compound when the acute effects had subsided. We emphasize the importance of being aware of the potential for OP compounds to cause late onset asystole and the need for continued EKG monitoring even after the acute symptoms appear to have settled.