Cardiac arrhythmias the first month after acute traumatic spinal cord injury

Abstract

Objective: Cardiovascular complications including cardiac arrest and arrhythmias remain a clinical challenge in the management of acute traumatic spinal cord injury (SCI). Still, there is a lack of knowledge regarding the characteristics of arrhythmias in patients with acute traumatic SCI. The aim of this prospective observational study was to investigate the occurrence of cardiac arrhythmias and cardiac arrests in patients with acute traumatic SCI. Methods: As early as possible after SCI 24-hour Holter monitoring was performed. Additional Holter recordings were performed 1, 2, 3, and 4 weeks after SCI. Furthermore, 12-lead electrocardiograms (ECGs) were obtained shortly after SCI and at 4 weeks. Results: Thirty patients were included. Bradycardia (heart rate (HR) <50 b.p.m.) was present in 17-35% of the patients with cervical (C1-C8) SCI (n = 24) within the first 14 days. In the following 14 days, the occurrence was 22-32%. Bradycardia in the thoracic (Th1-Th12) SCI group (n = 6) was present in 17-33% during the observation period. The differences between the two groups were not statistically significant. The mean minimum HR was significantly lower in the cervical group compared with the thoracic group both on 12-lead ECGs obtained shortly after SCI (P = 0.030) and at 4 weeks (P = 0.041). Conclusion: Many patients with cervical SCI experience arrhythmias such as bradycardia, sinus node arrest, supraventricular tachycardia, and more rarely cardiac arrest the first month after SCI. Apart from sinus node arrests and limited bradycardia, no arrhythmias were seen in patients with thoracic SCI. Standard 12-lead ECGs will often miss the high prevalence these arrhythmias have.

Electrocardiographic abnormalities in the early stage following traumatic spinal cord injury

“…8,14,15 Bunten et al 13 reported that tetraplegics are more susceptible to low frequency and impaired variability of heart rate when compared with paraplegics and able-bodied individuals. Using both 24-h Holter monitoring and 12-lead ECG, Bartholdy et al 5 documented that patients with cervical SCI had significantly lower heart rates within the first month post injury when compared with patients with thoracic SCI. Their results also suggested that patients with cervical SCI are more susceptible to bradycardia, sinus node arrest, supraventricular tachycardia and, more rarely, cardiac arrest during the first month after cervical SCI, whereas only a few patients with thoracic SCI developed sinus node arrests and bradycardia.…”

“…Their results also suggested that patients with cervical SCI are more susceptible to bradycardia, sinus node arrest, supraventricular tachycardia and, more rarely, cardiac arrest during the first month after cervical SCI, whereas only a few patients with thoracic SCI developed sinus node arrests and bradycardia. 5 The present study is an original examination of several electrocardiographic parameters during the initial 72 h post trauma among patients grouped according to their level and severity of spine trauma. Overall, this study shows that patients with motor complete SCI at cervical or high-thoracic level had significantly longer RR interval, shorter QTc interval and more prolonged duration of the longest QRS complex than patients with less severe spine trauma caudal to the T6 level.…”

“…Nonetheless, a prior study has indicated several practical challenges (e.g., obtaining informed consent, sedation, surgery, other investigations, and transfer to other hospitals) that precluded obtaining a prolonged Holter recording in this group of patients. 5 Finally, all patients included in this study were admitted to a spine trauma center, which can also be a source of selection bias, even though it has the advantage of more specialized surgical and medical spine care.…”

“…4 In addition to hemodynamic abnormalities, SCI can lead to cardiac arrhythmia including sinus bradycardia, supraventricular arrhythmia, ventricular arrhythmia and cardiac arrest. [5][6][7][8] Although these cardiac arrhythmias are relatively well recognized in the subacute and chronic stages after SCI, there is a paucity of studies focused on abnormal cardiac electrical activity during the early stages following SCI.…”

Autonomic Response in Subjects with Spinal Cord Injury: Brief Comments

“…These results could be related to injury in the sympathetic innervation of the heart more that the unopposed parasympathetic activity thus helping to increase risk of atrioventricular blocks, ventricular arrhythmias and cardiac sudden death. 27 However, most studies measured the QT interval mainly during in the acute phase of the SCI, mainly after first month. 14,26,27 On the other hand, subjects with cervical SCI and practitioners of physical exercise showed reduction of the myocardial atrophy due changes in the pressure and volume imposed to the heart exercise-induced.…”