Background <p>Somatostatin analogs such as octreotide are frequently used in the prevention of carcinoid syndrome in the perioperative period following neuroendocrine tumor resection. This is the first reported case of ventricular asystole associated with postoperative intravenous octreotide infusion in a patient with previous congenital cardiac surgery.</p> Case presentation <p>We present the case of a 62-year-old white British male patient with a history of previous congenital cardiac surgery who sustained multiple episodes of ventricular asystole and associated loss of cardiac output during octreotide infusion. Recurrent asystole ceased following discontinuation of the octreotide infusion.</p> Conclusion <p>Physicians caring for patients receiving intravenous octreotide should be aware of the potential arrhythmogenic adverse effects. While specific risk factors for octreotide-associated arrhythmias are not generally understood, previous cardiac surgery could potentially be one of these. Risk stratification guidance regarding patient groups requiring heightened monitoring while receiving intravenous octreotide is required. Monitoring recommendations may involve invasive blood pressure monitoring and telemetry in these cases.</p>