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01-06-2009 | Original Article

Ventricular Arrhythmia Risk After Subarachnoid Hemorrhage

Authors: J. Michael Frangiskakis, Marilyn Hravnak, Elizabeth A. Crago, Masaki Tanabe, Kevin E. Kip, John Gorcsan III, Michael B. Horowitz, Amin B. Kassam, Barry London

Published in: Neurocritical Care | Issue 3/2009

Abstract

Introduction

Cardiac morbidity and mortality after aneurysmal subarachnoid hemorrhage (SAH) are attributable to myocardial injury, decreased ventricular function, and ventricular arrhythmia (VA). Our objective was to test the relationships between QTc prolongation, VA, and survival after SAH.

Methods

In 200 subjects with acute aneurysmal SAH, electrocardiograms, echocardiograms, and telemetry were evaluated. Serum electrolytes and troponin were also evaluated.

Results

Initial QTc (mean 460 ± 45 ms) was prolonged (≥470 ms) in 38% of subjects and decreased on follow-up (469 ± 49 initial vs. 435 ± 31 ms follow-up; N = 89; P < 0.0001). VA was present in 14% of subjects, 52% of subjects with VA had QTc ≥ 470 ms, and initial QTc trended toward longer duration in subjects with VA (474 ± 61 vs. 457 ± 42 ms; P = 0.084). Multivariate analysis demonstrated significant predictors of VA after SAH were increasing age (OR 1.3/5 years; P = 0.025), increasing stroke severity (OR 1.8; P = 0.009), decreasing heart rate (OR 0.5/10 beats/min; P= 0.006), and the absence of angiotensin converting enzyme inhibitor or angiotensin II receptor antagonist use at SAH onset (OR 0.10; P = 0.027). All-cause mortality was 19% (25/135) at 3 months and subjects with VA had significantly higher mortality than those without VA (37% vs. 16%; P = 0.027).

Conclusions

These data demonstrate that QTc prolongation and arrhythmias are frequently noted after SAH, but arrhythmias are often not associated with QTc prolongation. In addition, the presence of VA identified subjects at greater risk of mortality following their SAH.

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Title: Ventricular Arrhythmia Risk After Subarachnoid Hemorrhage
Authors: J. Michael Frangiskakis
Marilyn Hravnak
Elizabeth A. Crago
Masaki Tanabe
Kevin E. Kip
John Gorcsan III
Michael B. Horowitz
Amin B. Kassam
Barry London
Publication date: 01-06-2009
Publisher: Humana Press Inc
Published in: Neurocritical Care / Issue 3/2009
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI: https://doi.org/10.1007/s12028-009-9188-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Ventricular Arrhythmia Risk After Subarachnoid Hemorrhage

Abstract

Introduction

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

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