Serious Cardiac Arrhythmias May Occur During First 72 Hours After Stroke

Stroke alert

By Matthew E. Fink, MD, Professor and Chairman, Department of Neurology, Weill Cornell Medical College, and Neurologist-in-Chief, New York Presbyterian Hospital. Matthew Fink, MD, is a retained consultant for MAQUET.

This article originally appeared in the December 2012 issue of Neurology Alert. It was peer reviewed by M. Flint Beal, MD. Dr. Beal is Anne Parrish Titzel Professor, Department of Neurology and Neuroscience, Weill Cornell Medical Center. Dr. Beal reports no financial relationships relevant to this field of study.

Source: Kallmunzer B, et al. Serious cardiac arrhythmias after stroke: Incidence, time course, and predictors — a systematic, prospective analysis. Stroke 2012;43:2892-2897.

Investigators of the stroke arrhythmia monitoring Database in Erlangen, Germany, performed continuous telemetric cardiac rhythm monitoring on 501 acute stroke patients admitted to their stroke unit. Arrhythmias were systematically detected and categorized in a prospective fashion, and time of onset and predisposing factors were noted.

Significant cardiac arrhythmias occurred in 25.1% of all patients during the 72 hours of monitoring, with the highest risk period being the first 24 hours after admission. Serious tachyarrhythmias (ventricular or supraventricular arrhythmias > 130 beats per minute) were more frequent then bradyarrhythmias. All arrhythmias were independently associated with higher patient age and higher NIH Stroke Scale scores (more severe stroke). The risk of serious cardiac arrhythmias declines during the first 72 hours after stroke and is at highest risk during the first 24 hours. Patients with more severe strokes and advanced age are at highest risk, and continuous cardiac monitoring is strongly advised during the initial 3 days of hospitalization.