Journal article
Ventricular Arrhythmia Risk After Subarachnoid Hemorrhage
Neurocritical care, Vol.10(3), pp.287-294
2009
DOI: 10.1007/s12028-009-9188-x
PMCID: PMC3673292
PMID: 19184553
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 (> or = 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 > or = 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.
Details
- Title: Subtitle
- Ventricular Arrhythmia Risk After Subarachnoid Hemorrhage
- Creators
- J. Michael Frangiskakis - Cardiovascular Institute, University of Pittsburgh Medical Center, S572 Scaife Hall, 200 Lothrop Street, Pittsburgh, PA 15213, USAMarilyn Hravnak - Department of Neurosurgery, University of Pittsburgh Medical Center, A402, 200 Lothrop Street, Pittsburgh, PA 15213, USAElizabeth A Crago - Department of Neurosurgery, University of Pittsburgh Medical Center, A402, 200 Lothrop Street, Pittsburgh, PA 15213, USAMasaki Tanabe - Cardiovascular Institute, University of Pittsburgh Medical Center, S572 Scaife Hall, 200 Lothrop Street, Pittsburgh, PA 15213, USAKevin E Kip - College of Nursing, University of South Florida, MDC 22 Rm 2010, 12901 Bruce B. Downs Blvd, Tampa, FL 33612, USAJohn Gorcsan - Cardiovascular Institute, University of Pittsburgh Medical Center, S572 Scaife Hall, 200 Lothrop Street, Pittsburgh, PA 15213, USAMichael B Horowitz - Department of Neurosurgery, University of Pittsburgh Medical Center, A402, 200 Lothrop Street, Pittsburgh, PA 15213, USAAmin B Kassam - Department of Neurosurgery, University of Pittsburgh Medical Center, A402, 200 Lothrop Street, Pittsburgh, PA 15213, USABarry London - Cardiovascular Institute, University of Pittsburgh Medical Center, S572 Scaife Hall, 200 Lothrop Street, Pittsburgh, PA 15213, USA
- Resource Type
- Journal article
- Publication Details
- Neurocritical care, Vol.10(3), pp.287-294
- DOI
- 10.1007/s12028-009-9188-x
- PMID
- 19184553
- PMCID
- PMC3673292
- NLM abbreviation
- Neurocrit Care
- ISSN
- 1541-6933
- eISSN
- 1556-0961
- Grant note
- R01 HL074316 || HL / National Heart, Lung, and Blood Institute : NHLBI
- Language
- English
- Date published
- 2009
- Academic Unit
- Molecular Physiology and Biophysics; Cardiovascular Medicine; Internal Medicine
- Record Identifier
- 9984025329802771
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