Q-T prolongation and polymorphous (“torsade de pointes”) ventricular arrhythmias associated with organophosphorus insecticide poisoning

Ludomirsky, Achiyahu; Klein, Herman O.; Sarelli, Pinchas; Becker, Bruno; Hoffman, Seymour; Taitelman, U; Barzilai, Jacob; Lang, Roberto M.; David, Daniel; DiSegni, Elio; Kaplinsky, Elieser

doi:10.1016/0002-9149(82)90242-9

Cited by 184 publications

(67 citation statements)

References 19 publications

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“…In a large series, these so called "toxic repolarization anomalies" in the form of QTc prolongations and pathologic repolarization (diffuse ST-and T-inversion anomalies), were present in up to 134 out of 168 cases (3). This high incidence of these ECG changes has been confirmed by others (1,4), eventually leading to polymorphic ventricular tachycardia of the torsade de pointe type (4,5). Moreover these impressive electrocardiographic changes mimicking severe ischemia have been reported from the first up to the twentieth day depending on the severity of the intoxication (3).…”

supporting

confidence: 56%

“…Moreover these impressive electrocardiographic changes mimicking severe ischemia have been reported from the first up to the twentieth day depending on the severity of the intoxication (3). It has been proposed that this consists of different phases: a (brief) transient phase of intense increased sympathetic tone, resulting in serious tachycardia, followed by a prolonged period of extreme parasympathetic activity, causing sinus bradycardia, atrioventricular block, ST segment, and T wave abnormalities and QTc interval prolongation (1,5). As these changes have been described even during high-dose atropine treatment, the proposed protective effect of atropine on arrhythmias could not be verified.…”

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confidence: 99%

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Impressive but classical electrocardiograph changes after organophosphate poisoning

Robert

Thielen

Brabant³

2008

Clinical Toxicology

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confidence: 56%

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confidence: 99%

Impressive but classical electrocardiograph changes after organophosphate poisoning

Robert

Thielen

Brabant³

2008

Clinical Toxicology

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“…Multifocal PVC's, Idioventricular arrhythmias, AF, VF, transient ST-T changes and different grades of heart blocks including complete heart block are also seen in OPC-Poisoning. [8][9][10][11] The mechanism of cardiac toxicity is caused by more than one mechanism and are sympathetic, parasympathetic overactivity, hypoxemia, acidosis, electrolyte derangements and direct toxicity on myocardium and conduction system of the heart. 12,13 The antidote Atropine may itself induce arrhythmia.…”

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confidence: 99%

Study of clinical profile of organophosphorus poisoning with special reference to electrocardiographic changes and electrolyte derangement

et al. 2018

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Background: Organophosphorus Compounds (OPC) are main cause of accidental and suicidal poisoning in agrarian countries like India. Aim was to study the clinical profile of OPC-Poisoning and correlate it with the electrocardiographic (ECG) changes and electrolyte abnormalities.Methods: Hundred consecutive cases admitted to Medicine Department underwent clinical examination, ECG, electrolytes, Acetyl Choline Esterase (AChE) estimation from time to time and Paradeniya Organophosphorus Poisoning (POP) score at the time of admission. All these parameter with duration of hospital stay and outcome were statistically analysed using X2 test, Fisher exact test, and inference was drawn.Results: In hundred OPC-Poisoning patients [Male (n=48), Female (n=52), M: F ratio 0.92:1] with mean age of 37.78±12.95 years, commonest poison was cholropyrifos+cypermethrin and was mostly suicidal (96%). Common symptoms were sweating (48%), salivation, blurring of vision, breathlessness and signs were smell of poison (90%), tachypnea, altered sensorium, miosis and fasciculation. POP scoring found 41% of patients in mild, 26% in moderate and 33% in sever grade of poisoning. Hospital stay ranged from 4-18 days. Complications were pulmonary Edema (PE) in 28%, Respiratory Failure (RF) 18%, Aspiration Pneumonia (AP) 15% and Intermediate Syndrome (IS) 4%. 10 died out of 42 patients who had complications and the cause of death was RF in 4, Ventricular Fibrillation (VF) 2 and IS in 2. ECG finding showed sinus tachycardia (31%), prolonged corrected QT (QTc) interval (28%), sinus bradycardia (25%), ST-T changes (17%) and Premature Ventricular Contraction (PVC) in 4% which degenerated to VF in 2%. 24 patients were Hypokalemic from which 16 developed complications.Conclusions: Similar to earlier studies we observed poisoning which was suicidal. QTc prolongation and Hypokalemia are associated with high morbidity and mortality in OPC-Poisoning.

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“…ECG abnormalities-such as QT-interval prolongation and polymorphic ventricular tachycardia (e.g., torsades de pointes), ST-T changes, and disturbance of the cardiac conduction system in OPP-have been reported previously [23][24][25][26][27][28]. The mechanism by which OPs cause cardiotoxic effects is not yet known, but cholinergic innervation of the heart results in both negative chronotropy and negative inotropy that slows myocardial conduction or repolarization [20].…”

Section: Discussionmentioning

confidence: 95%

Prognostic value of long QT interval in acute and severe organophosphate poisoning

et al. 2009

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Introduction: Suicidal poisoning with organophosphorus (OP) pesticides is common, particularly from rural areas. This highlights the importance of determining an OP poisoning prognosis to decide how aggressive treatment should be. There are reports suggesting a relationship between prolonged corrected QT (QTC) interval and the severity of poisoning. We aimed to evaluate the prognostic utility of this clinical tool in OP poisoning (OPP) patients.Methods: Patients with the primary diagnosis of OPP who were admitted to the intensive care unit (ICU) of Loghman-Hakim Hospital Poison Centre (LHHPC) were the subjects of this prospective study. Cholinesterase (CE) activity and the QTC interval was determined for each patient using the Bazett formula and considering <440 msec as normal. Comparative outcomes of the study were duration of both hospitalization and mechanical ventilation, serum CE activity on admission and its daily level, total amount of atropine administered, analysis of the QT and QTC intervals in the primary ECG on admission and at the end of hospitalization, and rate of mortality.Results: The study included 42 patients with a diagnosis of OPP. The mean age of the patients was 32, ranged from 12 to 81 years old. The mortality rate was 37.5%. There was no significant difference between two groups (prolonged and normal QTC intervals) according to gender and age (p = .491 and p = .133, respectively). The CE level for long and normal QTC interval groups was 3.90 Ϯ 0.33 kU/L vs. 4.41 Ϯ 0.23 kU/L, respectively. The mortality rate in the long QTC group was significantly higher than that of the normal QTC group (p = .044). Moreover, the average period of hospitalization in patients with prolonged QTC interval was higher than the other group (p = .02). The average atropine required to control the muscarinic signs and symptoms such as salivation, bronchorrehea, and miosis in patients with prolonged QTC interval was 38.60 mg; in patients with normal QTC interval it was 20.02 mg (p = .013).Conclusion: QTC interval prolongation may have prognostic value in OPP.

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Q-T prolongation and polymorphous (“torsade de pointes”) ventricular arrhythmias associated with organophosphorus insecticide poisoning

Cited by 184 publications

References 19 publications

Impressive but classical electrocardiograph changes after organophosphate poisoning

Impressive but classical electrocardiograph changes after organophosphate poisoning

Study of clinical profile of organophosphorus poisoning with special reference to electrocardiographic changes and electrolyte derangement

Prognostic value of long QT interval in acute and severe organophosphate poisoning

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