Permanent cardiac pacemaker for cardiac arrest following cervico-dorsal spinal injury

Abstract

Bradycardia and rarely cardiac arrest as a complication of cervical spine injury due to reduced sympathetic activity is well known, which usually settles down in 4-6 weeks of injury. There are few case reports in literature of high cervical spinal cord injury requiring permanent cardiac pacemaker due to this complication, but an injury as low as cervico-dorsal junction requiring permanent cardiac pacemaker has never been reported. A 47-year-old male suffered traumatic C7-D1 dislocation and continued to have severe bradycardia with multiple episodes of cardiac arrest till 2 months after injury, which finally warranted permanent cardiac pacemaker as a life saving measure. Following permanent cardiac pacemaker no cardiac arrest occurred and the patient was successfully rehabilitated. The case directs our attention to a rare complication of cardiac arrest occurring in an injury as low as cervico-dorsal junction when all other causes are ruled out and shows importance of using permanent cardiac pacemaker to ensure patient safety in community.

Cardiac pacing in patients with a cervical spinal cord injury

“…Bradycardias may persist for 2 months after injury. 19 Our two patients who received a permanent pacemaker required to do so at 4 weeks after injury and within 2 weeks of transvenous pacemaker insertion. One patient experienced an infection of the transvenous pacemaker, before the permanent pacemaker could be implanted.…”

“…Power spectral analysis of the heart rate from such patients confirms a shift towards a predominant vagal tone on the heart rate. 19 However, power spectral analysis of the heart rate has not been validated as a predictive tool for the need of a cardiac pacemaker. In a closely aligned report, fewer episodes of bradycardia were noted with the progression to spontaneous ventilation among patients with cervical SCI.…”

Cardiac arrest attributable to dysfunction of the autonomic nervous system after traumatic cervical spinal cord injury

“…Cardiac pacemaker implantation is indicated for patients with high-level SCIs and continuing symptomatic bradycardia and they do not respond to medical management or suffer recurrent cardiac arrests 19 . Sanghvi et al described a patient with a traumatic C 7 –D 1 dislocation who experienced continuous severe bradycardia and cardiac arrest for 2 months after injury 7 . Ultimately, a permanent cardiac pacemaker was inserted.…”

Ethics in Electrophysiology: Who Speaks for this Man?

“…Cervical spine trauma can be associated with bradycardia and rarely complete atrioventricular block or cardiac arrest 1 . The peak incidence of sinus arrest is within the first 2 weeks of injury, but persistent sinus arrest requiring permanent pacing has occurred up to 2 months after the initial event 2,3 . The long‐term incidence of permanent sinus node dysfunction in this population is not known.…”

“…There are several potential options: (1) Pacemaker generator replacement is an easy option, and because sinus node dysfunction is hard to predict, the patient's heart rate would always be supported. (2) The pacemaker generator may be allowed to expire without replacement (abandonment) during monitoring for *Research with Novartis.…”