Atrial Fibrillation Associated With Autonomic Dysreflexia

Pine, Zachary M.; Miller, Stephen D.; Alonso, Joseph

doi:10.1097/00002060-199110000-00008

Cited by 69 publications

(35 citation statements)

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“…Furthermore, these studies have all examined the incidence of arrhythmia at rest, and few studies have investigated arrhythmia during cardiovascular stress or autonomic dysreflexia. However, there is some evidence to indicate, as reported in the present study, that autonomic dysreflexia may be associated with cardiac arrhythmias, particularly atrial fibrillation (4,5,28), which may require pharmacologic conversion to restore the normal rhythm (5). Furthermore, a case report in a young woman with SCI at the level of T5 describes profound cardiac irregularities during autonomic dysreflexia triggered by uterine contractions during labor, in which there was a clear relationship between the severity of autonomic dysreflexia and the arrhythmia (29).…”

Section: Cardiovascular Control During Vibrostimulationsupporting

confidence: 49%

“…Likewise, frequent premature atrial contractions may predispose one to atrial fibrillation (45,46), which is known to be associated with serious cardiovascular and cerebrovascular events (47). Indeed, atrial fibrillation is documented in the SCI population during sperm retrieval (5) and autonomic dysreflexia (4,28). Second, the arrhythmias noted in the present study tended to occur concurrently with episodes of autonomic dysreflexia.…”

Section: Limitationsmentioning

confidence: 53%

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Cardiovascular Responses to Vibrostimulation for Sperm Retrieval in Men With Spinal Cord Injury

Claydon

Elliott

Sheel

et al. 2006

The Journal of Spinal Cord Medicine

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Background/Objective: Cardiovascular abnormalities and arrhythmias are common in individuals with spinal cord injury (SCI) who are undergoing vibrostimulation for sperm retrieval. The study aimed to examine cardiovascular control in men with SCI undergoing this procedure.Methods: Individuals with chronic cervical (n ¼ 8; age: 33.1 6 1.9 years) and upper thoracic SCI (n ¼ 5; age: 35.2 6 2.9 years) volunteered for vibrostimulation, with continuous blood pressure (Finometer) and electrocardiographic monitoring. Patients were characterized further by sympathetic skin responses (SSR) to assess descending autonomic spinal pathways and American Spinal Injury Association (ASIA) scores to assess motor and sensory pathways.Results: All but one subject with cervical SCI were ASIA A or B and were negative for SSR in the hands and feet. All subjects with upper thoracic SCI were ASIA A or B and were positive for SSR in the hands. Systolic blood pressure was lower in men with cervical injury at rest. Vibrostimulation induced an increase in systolic blood pressure .20 mmHg in all patients with cervical SCI (range ¼ 125/65-280/152; median ¼ 167/143 mmHg) and in 2 thoracic subjects (151/104 and 170/121 mmHg). During ejaculation, 6 cervical and 3 thoracic subjects developed arrhythmias (5 with bradycardia, 6 with premature atrial contractions, 4 with ventricular excitation, 1 with junctional rhythm, and 1 with heart block). Conclusion:The vibrostimulation procedure induced electrocardiographic abnormalities and autonomic dysreflexia in subjects with either cervical or high thoracic SCI.

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Section: Cardiovascular Control During Vibrostimulationsupporting

confidence: 49%

Section: Limitationsmentioning

confidence: 53%

Cardiovascular Responses to Vibrostimulation for Sperm Retrieval in Men With Spinal Cord Injury

Claydon

Elliott

Sheel

et al. 2006

The Journal of Spinal Cord Medicine

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“…If left untreated, AD can cause serious complications, including intracranial hemorrhage, myocardial infarction, retinal detachments, seizures and even death. [41][42][43][44] Although there is still no consensus on the exact pathophysiology explaining AD, it is generally accepted that loss of supraspinal input to the spinal sympathetic circuits, reduced overall sympathetic activity, disruption of spinal reflexes and plastic changes in the spinal cord and peripheral autonomic circuits all contribute to the development of AD. 2 In addition to the debilitating consequences of AD noted above, it is also possible that such repetitive and significant blood pressure elevations could induce a shear injury to the blood vessel endothelium, predisposing these individuals to cardiovascular complications in the future.…”

Section: Organization Of the Autonomic Nervous Systemmentioning

confidence: 99%

Peripheral vascular function in spinal cord injury: a systematic review

et al. 2012

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Background: During the past 20 years, significant advances in patient care have resulted in individuals with spinal cord injury (SCI) living longer than before. As lifespan increases, cardiovascular complications are emerging as the leading cause of mortality in this population, and individuals with SCI develop cardiovascular disease at younger ages than their able-bodied counterparts. To address this increasing clinical challenge, several recent studies investigated the central cardiovascular adaptations that occur following SCI. However, a somewhat less recognized component of cardiovascular dysfunction in this population is the peripheral vascular adaptations that also occur as a result of SCI. Study design: Literature review.Objective: To present a comprehensive overview of changes in arterial structure and function, which occur after SCI. Setting: Canada. Methods: A systematic literature review was conducted to extract studies that incorporated measures of arterial structure or function after SCI in animals or humans. Results: Individuals with SCI exhibit vascular dysfunction below the lesion that is characterized by a reduction in conduit artery diameter and blood flow, increased shear rate and leg vascular resistance, and adrenoceptor hyper-responsiveness. There is also recent alarming evidence for central arterial stiffening in individuals with SCI. Conclusion: Although physical deconditioning is the primary candidate responsible for the maladaptive remodeling of the peripheral vasculature after SCI, there is emerging evidence that blood pressure oscillations, such as those occurring in the large majority of individuals with SCI, also exacerbates vascular dysfunction in this population.

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“…These abnormalities may directly reflect disruption of the sympathetic circuits within the upper thoracic segments (T1-T5). However, cardiac efferent parasympathetic control, which arises from the brain stem, remains intact after SCI and may also contribute to the bradycardia observed in those with tetraplegia [21][22].…”

Section: Cardiac Dysrhythmiasmentioning

confidence: 99%

Assessment of autonomic dysfunction following spinal cord injury: Rationale for additions to International Standards for Neurological Assessment

Krassioukov

Karlsson

Wecht³

et al. 2007

JRRD

168

123

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Abstract-We present a preliminary report of the discussion of the joint committee of the American Spinal Injury Association (ASIA) and the International Spinal Cord Society concerning the development of assessment criteria for general autonomic function testing following spinal cord injury (SCI). Elements of this report were presented at the 2005 annual meeting of the ASIA. To improve the evaluation of neurological function in individuals with SCI and therefore better assess the effects of therapeutic interventions in the future, we are proposing a comprehensive set of definitions of general autonomic nervous system dysfunction following SCI that should be assessed by clinicians. Presently the committee recommends the recognition and assessment of the following conditions: neurogenic shock, cardiac dysrhythmias, orthostatic hypotension, autonomic dysreflexia, temperature dysregulation, and hyperhidrosis.

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Atrial Fibrillation Associated With Autonomic Dysreflexia

Cited by 69 publications

References 0 publications

Cardiovascular Responses to Vibrostimulation for Sperm Retrieval in Men With Spinal Cord Injury

Cardiovascular Responses to Vibrostimulation for Sperm Retrieval in Men With Spinal Cord Injury

Peripheral vascular function in spinal cord injury: a systematic review

Assessment of autonomic dysfunction following spinal cord injury: Rationale for additions to International Standards for Neurological Assessment

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