Paroxysmal Atrial Fibrillation After Pretroid And Organic Phosphor Intoxication

摘要

Cypermethrin is one of the synthetic pretroid insecticides which are common using for agriculture, home and veterinary application because of its high biological efficacy and low toxicity for mammals . Dichlorvos is an insecticide and an antihelminthes which is used to control insects primarily in storage areas and barns. It is a member of organic phosphor family with wide spectrum. We checked the literature, we saw only one case for paroxysmal atrial fibrillation due to side effect of organic phosphor agents. In our study, we evaluate two paroxysmal atrial fibrillation cases without any cardiac pathology after accidental Cypermethrin inhalation and accidental Dichlorvos ingestion. Introduction Cypermethrin is one of the synthetic pretroid insecticides which are common using for agriculture, home and veterinary application because of its high biological efficacy and low toxicity for mammals . Due to pretroids' negligible absorption of skin, they can cause systemic toxicities by inhalation or orally. In mild affected cases fatigue, nausea, vomiting, hypersalivation, dizziness and some neuropathy symptoms can be seen (1). Dichlorvos is an insecticide and an antihelminthes which is used to control insects primarily in storage areas and barns. It is a member of organic phosphor family with wide spectrum (2). In literature, organic phosphor compounds cause cardiac conduction defects by their over stimulation of muscarinic receptors and affects on respiratuvar or circulative centre in nervous system but the mechanism is unclear (3). Although when we checked the literature, we saw only one case for paroxysmal atrial fibrillation. In our study, we evaluate two paroxysmal atrial fibrillation cases without any cardiac pathology after accidental Cypermethrin inhalation and accidental Dichlorvos ingestion. Case 1 A twenty five years old male farmer applied to our emergency department with nausea, vomiting, dizziness, palpitation, pins and needles in extremities after two hours of applying insecticide to his farm. In his examination there was no pathological sign, arterial blood pressure was 120/80 mmHg. A complete blood count, thyroid tests, blood gases and blood electrolytes (Na, K, Mg, Ca) were normal. We performed electrocardiogram (ECG), it was atrial fibrillation with rate approximately 115/min (figure 1 a). We administered supplementary treatment, no anti arrhythmic medication applied. Twelve hours after admission, the AF spontaneously converted to sinus rhythm (figure 1 b). During continuous ECG monitoring in the emergency department, no recurrence of the arrhythmia was observed. A transthoracic echocardiography found no structural or functional anomaly. Finally, no etiology other than the Cypermethrin inhalation could explain this AF episode. We discharged the patient at his twenty fourth hour of admission. Case 2 A thirty years old male ingested Dichlorvos accidentally about an hour before admission. Hypersalivation, nausea, vomiting were developed. His Glasgow Coma Scale was 15, arterial blood pressure was 130/80 mmHg. The ECG revealed atrial fibrillation (120/min) (figure 1 c). His all laboratory parameters (especially serum levels of TSH, fT3, fT4) were in normal range and lack of any respiratory distress, hypoxia, cardiac enzyme level increase, or ECG signs showing ischemia rules out any pulmonary or cardiac causes of this patient's AF. No cardiac pathologic sign or diagnoses were in his past. Gastric lavage and active charcoal, intra venous fluid performed. One gram of pralidoxim infused by vein line. No anti arrhythmic treatment applied. Six hours after admission, the AF spontaneously converted to sinus rhythm (figure 1 d). Echocardiography demonstrated no structural or functional heart disturbances. He discharged after 72 hours of admission without any repetition of arrhythmia.