J Cerebrovasc Endovasc Neurosurg.  2012 Jun;14(2):90-94. 10.7461/jcen.2012.14.2.90.

Clinically Significant Cardiac Arrhythmia in Patients with Aneurysmal Subarachnoid Hemorrhage

Affiliations
  • 1Department of Neurosurgery, College of Medicine, Dong-A University, Busan, Korea. hdkim@damc.or.kr

Abstract


OBJECTIVE
Many previous studies have shown that electrocardiographic (ECG) changes occur patients with subarachnoid hemorrhage (SAH). This study was designed to identify the frequency, influencing factors, and outcome of clinically significant cardiac arrhythmias after SAH.
METHODS
We retrospectively analyzed clinical data of 122 patients including ECG finding, age, sex, the Hunt-Hess grade, the Fisher's grade, the history of hypertension, peak blood pressure and heart rate, location of aneurysm, Glasgow Outcome Scale (GOS) score, the days of admission to the intensive care unit, the presence of symptomatic vasospasm.
RESULTS
Of 122 SAH patients, 50% (n = 61) had a verified clinically significant arrhythmia. There were no statistically significant independent factors associated with clinically significant arrhythmia in multivariate analysis. Although adjustments for the effects of age, Hunt-Hess grade, and the presence of symptomatic vasospasm on death were made, clinically significant arrhythmias were still independently predictive of death (no arrhythmia versus arrhythmia, 11.5% versus 27.9%, adjusted odds ratio [OR] 3.524, 95% confidence interval [CI] 1.229-10.100, p = 0.019) and poor outcome (GOS < or = 2, 13.1% versus 29.5%, adjusted OR 3.202, 95% CI 1.174-8.732, p= 0.023).
CONCLUSION
Clinically significant arrhythmias after SAH are associated with a high mortality rate, and serious cardiac and neurological comorbidity. Patients with an abnormal ECG on admission should undergo close cardiac monitoring, and the presence of rhythm disturbances should prompt aggressive measures to treat myocardial infarction (MI), maintain a normal cardiac rhythm, and minimize the presence of autonomic stress.

Keyword

Arrhythmia; Death; Subarachnoid hemorrhage

MeSH Terms

Aneurysm
Arrhythmias, Cardiac
Blood Pressure
Comorbidity
Electrocardiography
Glasgow Outcome Scale
Heart Rate
Humans
Hypertension
Intensive Care Units
Multivariate Analysis
Myocardial Infarction
Odds Ratio
Retrospective Studies
Subarachnoid Hemorrhage

Reference

1. Andreoli A, di Pasquale G, Pinelli G, Grazi P, Tognetti F, Testa C. Subarachnoid hemorrhage: frequency and severity of cardiac arrhythmias. A survey of 70 cases studied in the acute phase. Stroke. 1987. May-Jun. 18(3):558–564.
Article
2. Brouwers PJ, Wijdicks EF, Hasan D, Vermeulen M, Wever EF, Frericks H, et al. Serial electrocardiographic recording in aneurysmal subarachnoid hemorrhage. Stroke. 1989. 09. 20(9):1162–1167.
Article
3. Chatterjee S. ECG Changes in Subarachnoid Haemorrhage: A Synopsis. Neth Heart J. 2011. 01. 19(1):31–34.
Article
4. Cruickshank JM, Neil-Dwyer G, Stott AW. Possible role of catecholamines, corticosteroids, and potassium in production of electrocardiographic abnormalities associated with subarachnoid haemorrhage. Br Heart J. 1974. 07. 36(7):697–706.
Article
5. Di Pasquale G, Pinelli G, Andreoli A, Manini G, Grazi P, Tognetti F. Holter detection of cardiac arrhythmias in intracranial subarachnoid hemorrhage. Am J Cardiol. 1987. 03. 59(6):596–600.
Article
6. Eisalo A, Peräsalo J, Halonen PI. Electrocardiographic abnormalities and some laboratory findings in patients with subarachnoid haemorrhage. Br Heart J. 1972. 03. 34(3):217–226.
Article
7. Estanol BV, Loyo MV, Mateos JH, Foyo E, Cornejo A, Guevara J. Cardiac arrhythmias in experimental subarachnoid hemorrhage. Stroke. 1977. Jul-Aug. 8(4):440–449.
Article
8. Estanol BV, Marin OS. Cardiac arrhythmias and sudden death in subarachnoid hemorrhage. Stroke. 1975. Jul-Aug. 6(4):382–386.
Article
9. Estanol Vidal B, Badui Dergal E, Cesarman E, Marin San Martin O, Loyo M, Vargas Lugo B, et al. Cardiac arrhythmias associated with subarachnoid hemorrhage: prospective study. Neurosurgery. 1979. 12. 5(6):675–680.
10. Frontera JA, Parra A, Shimbo D, Fernandez A, Schmidt JM, Peter P, et al. Cardiac Arrhythmias after Subarachnoid Hemorrhage: Risk Factors and Impact on Outcome. Cerebrovasc Dis. 2008. 26(1):71–78.
Article
11. Jeon IC, Chang CH, Choi BY, Kim MS, Kim SW, Kim SH. Cardiac Troponin I Elevation in Patients with Aneurysmal Subarachnoid Hemorrhage. J Korean Neurosurg Soc. 2009. 08. 46(2):99–102.
Article
12. Kreus KE, Kamila SJ, Takala JK. Electrocardiographic changes in cerebrovascular accidents. Acta Med Scand. 1969. Jan-Dec. 185(1-6):327–334.
Article
13. Lacy PS, Earle AM. Central neural control of blood pressure and cardiac arrhythmias during subarachnoid hemorrhage in rats. Stroke. 1985. Nov-Dec. 16(6):998–1002.
Article
14. Masuda T, Sato K, Yamamoto S, Matsuyama N, Shimohama T, Matsunaga A, et al. Sympathetic nervous activity and myocardial damage immediately after subarachnoid hemorrhage in a unique animal model. Stroke. 2002. 06. 33(6):1671–1676.
Article
15. Naidech AM, Kreiter KT, Janjua N, Ostapkovich ND, Parra A, Commichau C, et al. Cardiac troponin elevation, cardiovascular morbidity, and outcome after subarachnoid hemorrhage. Circulation. 2005. 11. 112(18):2851–2856.
Article
16. Rudehill A, Olsson GL, Sundqvist K, Gordon E. ECG abnormalities in patients with subarachnoid haemorrhage and intracranial tumours. J Neurol Neurosurg Psychiatry. 1987. 10. 50(10):1375–1381.
Article
17. Solenski NJ, Haley EC Jr, Kassell NF, Kongable G, Germanson T, Truskowski L, et al. Medical complications of aneurysmal subarachnoid hemorrhage: a report of the multicenter, cooperative aneurysm study. Participants of the Multicenter Cooperative Aneurysm Study. Crit Care Med. 1995. 06. 23(6):1007–1017.
18. Sommargren CE. Electrocardiographic abnormalities in patients with subarachnoid hemorrhage. Am J Crit Care. 2002. 01. 11(1):48–56.
Article
19. Zaroff JG, Rordorf GA, Newell BA, Ogilvy CS, Levinson JR. Cardiac outcome in patients with subarachnoid hemorrhage and electrocardiographic abnormalities. Neurosurgery. 1999. 01. 44(1):34–39. discussion 39-40.
Article
Full Text Links
  • JCEN
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr