**Introduction to Aluminum Phosphide Poisoning and Its Impact** Aluminum phosphide (ALP) poisoning is a significant public health concern, particularly in developing countries, due to its high lethality rate, which often exceeds 70%. When ingested, ALP releases phosphine gas, leading to severe cardiotoxic effects that can be detected through various electrocardiographic (ECG) abnormalities. These ECG patterns are crucial in predicting mortality among ALP poisoning patients, making early identification vital for guiding clinical interventions and improving patient outcomes. The high mortality rate associated with ALP poisoning highlights the need for a prognostic model that can predict the risk of mortality using ECG findings, especially in resource-limited settings where access to advanced medical facilities may be limited. **Study Objective, Methodology, and Key Findings** This retrospective cohort study aimed to develop a prognostic model that utilizes ECG findings to predict the risk of mortality in patients with ALP poisoning. Conducted at the Mardan Medical Complex from December 2022 to June 2024, the study included 64 patients diagnosed with ALP poisoning, categorizing them into survivors and non-survivors. The results showed significant differences in key variables between these groups, with non-survivors having a higher prevalence of atrial fibrillation, atrial premature beats, longer QT intervals, and QRS durations. They also had lower Glasgow Coma Scale (GCS) scores and shorter hospital stays, indicating rapid clinical decline. Non-survivors ingested a higher number of ALP pills, which was found to be a key determinant of the severity of cardiotoxic effects. The study's analysis, including Kaplan-Meier survival curves and logistic regression, confirmed that atrial fibrillation, QT prolongation, and wide QRS complexes were the strongest predictors of mortality. These findings suggest that recognizing the dose-dependent relationship between ALP ingestion and cardiotoxic effects can improve clinical outcomes by guiding the intensity of monitoring and treatment strategies based on the quantity of ALP exposure. The study's conclusions emphasize the importance of ECG patterns in predicting mortality and the need for early identification and intervention in ALP poisoning cases to reduce the fatality rate associated with this condition. Link: https://pubmed.ncbi.nlm.nih.gov/40235690/