Clinically Significant Cardiac Arrhythmia in Patients with Aneurysmal Subarachnoid Hemorrhage

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 ≤ 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.

Electrocardiographic and Echocardiographic Changes in Subarachnoid Hemorrhage and Their Final Impact on Early Outcome: A Prospective Study Before and After the Treatment

“…Near- ly all of the commonly reported ECG changes, however, have been included the repolarization waveforms (ST segment, T and U waves), which reflects a subendocardial damage and reinforces the "catecholamine storm" theory [14,17,21] as the responsible mechanism for SAH-related cardiac involvements: rapidly excessive catecholamine release after SAH results in subendocardial contraction band necrosis. The overall influence of the ECG changes on patients' outcome has also been a matter of dispute, whereas the observations by many authors, in support of our findings, are in favor of ECG playing a role in the outcome [11,22]; others found no prognostic value for ECG abnormalities [14,17,[23][24][25]. The same viewpoint, mentioned earlier, can also explain different results on both the types of the ECG changes after SAH and their presumed effect on patients' outcome.…”

“…Although some investigators, similar to us, found T-wave inversion as the most common post-SAH ECG abnormality [17,19], others reported something else [11,13,18,20]. Near- ly all of the commonly reported ECG changes, however, have been included the repolarization waveforms (ST segment, T and U waves), which reflects a subendocardial damage and reinforces the "catecholamine storm" theory [14,17,21] as the responsible mechanism for SAH-related cardiac involvements: rapidly excessive catecholamine release after SAH results in subendocardial contraction band necrosis.…”

“…Nevertheless, non-neurological complications of SAH such as hematologic alterations [5,6], electrolyte disturbances [7,8], and cardiac abnormalities are both common and potentially life-threatening [9]. Among all, cardiac manifestations after SAH have been well described for many years [10,11]; different types of abnormalities on electrocardiogram (ECG) and also some echocardiographic changes in the function of left ventricule (LV) have been reported. The final impact of cardiac findings on prognosis, however, has not been well understood.…”

Neurogenic stress cardiomyopathy following aneurysmal subarachnoid haemorrhage: a literature review

“…According to Ahmadian et al the most common ECG abnormalities for patients with NSC are T wave inversion -17.2%, ST interval depression -13.8% and prolonged QT interval -10.3% [33]. The prevalence of heart rhythm disorders ranges from 50% to 90% of patients [34,35]. The data concerning the prevalence differ depending on the study.…”

“…The data concerning the prevalence differ depending on the study. The most common disorders include sinus tachycardia, sinus bradycardia, atrial fibrillation and atrioventricular block [34][35][36]. Although the majority of the occurring arrhythmias are mostly benign, up to 5% can be clinically significant and life-threatening [37].…”