Refractory Torsades de Pointes in Organophosphate Poisoning: The Role of Temporary Overdrive Pacing

Background: Torsades de Pointes (TdP) is a life-threatening form of polymorphic ventricular tachycardia associated with QT interval prolongation. Acquired QT prolongation is commonly related to drugs, electrolyte disturbances, and metabolic or toxic conditions. Case Presentation: A 65-year-old woman was admitted following intentional organophosphate poisoning. During hospitalization, she developed progressive QTc prolongation complicated by recurrent episodes of polymorphic non-sustained ventricular tachycardia consistent with TdP. Despite correction of electrolyte abnormalities and intravenous magnesium sulfate administration, arrhythmias persisted. Temporary transvenous overdrive pacing resulted in immediate suppression of ventricular arrhythmias and QTc normalization. Conclusion: This case highlights the multifactorial etiology of acquired QT prolongation in organophosphate poisoning and supports early consideration of temporary pacing in refractory TdP to prevent fatal outcomes.