Cardiac Arrhythmias after Subarachnoid Hemorrhage: Risk Factors and Impact on Outcome

Abstract

Objective: Serious cardiac arrhythmias have been described in approximately 5% of patients after subarachnoid hemorrhage (SAH). The aim of this study was to identify the frequency, risk factors and clinical impact of cardiac arrhythmia after SAH. Methods: We prospectively studied 580 spontaneous SAH patients and identified risk factors and complications associated with the development of clinically significant arrhythmia. Multiple logistic regression analysis was used to calculate adjusted odds ratios for the effect of arrhythmia on hospital complications and 3-month outcome, as measured by the modified Rankin Scale, after controlling for age, neurological grade, APACHE-2 physiologic subscore, brain herniation and aneurysm size. Results: Arrhythmia occurred in 4.3% (n = 25) of patients. Atrial fibrillation and flutter were the most common arrhythmias, occurring in 76% (n = 19) of these patients. Admission predictors of cardiac arrhythmia included older age, history of arrhythmia and abnormal admission electrocardiogram (all p < 0.05). After adjusting for length of stay, hospital complications associated with arrhythmia included myocardial ischemia, hyperglycemia, and herniation (all p < 0.05). Arrhythmia was associated with an excess ICU stay of 5 days (p = 0.002). After adjusting for other predictors of outcome, arrhythmia was associated with an increased risk of death (adjusted OR 8.0, 95% confidence interval 1.9–34.0, p = 0.005), and death or severe disability (adjusted OR 6.9, 95% confidence interval 1.5–32.0, p = 0.014). Conclusions: Clinically important arrhythmias, most often atrial fibrillation or flutter, occurred in 4% of SAH patients. Arrhythmias are associated with an increased risk of cardiovascular comorbidity, prolonged hospital stay and poor outcome or death after SAH, after adjusting for other predictors of poor outcome.

ECG Changes in Subarachnoid Haemorrhage: A Synopsis

“…A recent study has found that arrhythmias are associated with an increased risk of cardiovascular comorbidity, prolonged hospital stay and poor outcome or death after SAH, after adjusting for other predictors of poor outcome [22]. Although no correlation was found between the frequency and severity of cardiac arrhythmias and the neurological condition, the site and extent of intracranial blood on computed tomography scan, or the location of ruptured malformation, the extremely high incidence of cardiac arrhythmias, sometimes serious, in the acute period after subarachnoid haemorrhage and the absence of clinical and radiological predictors make systematic continuous ECG monitoring compulsory to improve the overall results of subarachnoid haemorrhage, irrespective of early or delayed surgical treatment.…”

Early Events After Aneurysmal Subarachnoid Hemorrhage

“…Cardiac arrhythmias can occur as the fi rst symptom of acute SAH and are life threatening in 5-10 % of cases [ 27 ]. Major rhythmic abnormalities include sinus tachycardia, sinus bradycardia, and premature atrial and ventricular beats [ 25 ]. Myocardial injury is found in approximately 30-60 % of SAH patients and is associated with higher mortality [ 28 -30 ].…”

Subarachnoid haemorrhage mimicking as myocardial infarction

“…8 Alteration of rhythm and conduction have been detected in about 4% of patients with SAH, the most common arrhythmias are sinus bradycardia and atrial fibrillation/flutter (76% of arrhythmias observed by Frontera et al). 9 An electrocardiographic pattern was encountered in patients with cerebrovascular accidents which consisted primarily of T waves of large amplitude and duration. Large U waves were often present which may fuse in part or entirely within the T wave.…”