Cardiac arrhythmias after subarachnoid hemorrhage: Risk factors and impact on outcome

Jennifer A. Frontera, Augusto Parra, Daichi Shimbo, Andres Fernandez, J. Michael Schmidt, Patricia Peter, Jan Claassen, Katja E. Wartenberg, Fred Rincon, Neeraj Badjatia, Andrew Naidech, E. Sander Connolly, Stephan A. Mayer

Research output: Contribution to journalArticlepeer-review

67 Scopus citations

Abstract

Objective: Serious cardiac arrhythmias have been described in approximately 5% of patients after subarachnoid hemorrhage (SAH). The aim of this study was to identify the frequency, risk factors and clinical impact of cardiac arrhythmia after SAH. Methods: We prospectively studied 580 spontaneous SAH patients and identified risk factors and complications associated with the development of clinically significant arrhythmia. Multiple logistic regression analysis was used to calculate adjusted odds ratios for the effect of arrhythmia on hospital complications and 3-month outcome, as measured by the modified Rankin Scale, after controlling for age, neurological grade, APACHE-2 physiologic subscore, brain herniation and aneurysm size. Results: Arrhythmia occurred in 4.3% (n = 25) of patients. Atrial fibrillation and flutter were the most common arrhythmias, occurring in 76% (n = 19) of these patients. Admission predictors of cardiac arrhythmia included older age, history of arrhythmia and abnormal admission electrocardiogram (all p < 0.05). After adjusting for length of stay, hospital complications associated with arrhythmia included myocardial ischemia, hyperglycemia, and herniation (all p < 0.05). Arrhythmia was associated with an excess ICU stay of 5 days (p = 0.002). After adjusting for other predictors of outcome, arrhythmia was associated with an increased risk of death (adjusted OR 8.0, 95% confidence interval 1.9-34.0, p = 0.005), and death or severe disability (adjusted OR 6.9, 95% confidence interval 1.5-32.0, p = 0.014). Conclusions: Clinically important arrhythmias, most often atrial fibrillation or flutter, occurred in 4% of SAH patients. Arrhythmias are associated with an increased risk of cardiovascular comorbidity, prolonged hospital stay and poor outcome or death after SAH, after adjusting for other predictors of poor outcome.

Original languageEnglish (US)
Pages (from-to)71-78
Number of pages8
JournalCerebrovascular Diseases
Volume26
Issue number1
DOIs
StatePublished - Jul 2008

Keywords

  • Arrhythmia, risk factors
  • Atrial fibrillation
  • Outcome predictors
  • Subarachnoid hemorrhage

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

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