Cardiac arrhythmias six months following traumatic spinal cord injury

The Journal of Spinal Cord Medicine, 2022 · DOI: 10.1080/10790268.2021.1950453 · Published: July 1, 2022

Spinal Cord Injury Cardiovascular Science

Simple Explanation

Following a spinal cord injury (SCI), managing cardiovascular events, including arrhythmias, is a key challenge. Cervical SCI can disrupt sympathetic input to the heart, potentially leading to an imbalance in autonomic control. This study investigates the incidence of cardiac arrhythmias six months post-SCI, comparing individuals with cervical and thoracic injuries. It builds upon previous research, using continuous Holter monitoring to detect infrequent arrhythmias. The researchers hypothesized that arrhythmia incidence would decrease over time post-SCI and be less frequent in individuals with thoracic SCI compared to cervical SCI due to injury-level dependent autonomic dysfunction.

Study Duration

6 Months

Participants

55 participants with acute traumatic SCI

Evidence Level

Prospective observational study

Key Findings

1
Bradycardia was present in 29% and 33% of the participants with cervical and thoracic SCI six months after SCI, respectively, with no significant difference between the groups.
2
The mean maximum HR increased significantly from 4 weeks to 6 months post-SCI. However, mean minimum and maximum HR were not significantly different between the groups at the six-month time point.
3
There were no significant differences in the occurrences of arrhythmias between participants with cervical and thoracic SCI at six months compared to the findings observed in the first month.

Research Summary

This study assessed the occurrence of cardiac arrhythmias up to six months after SCI and found that arrhythmia occurrences observed in the first month post-SCI persisted, with no significant differences between cervical and thoracic groups at six months. Bradycardia was common in both cervical and thoracic SCI groups at six months. The mean maximum heart rate increased significantly from week 4 to month 6 in the cervical group and showed an increasing trend in the thoracic group. SA node arrests were observed in participants with cervical SCI at every time point. The occurrences of SVT were higher in the cervical group during the initial weeks but decreased over time.

Practical Implications

Cardiac Rehabilitation Strategies

The most crucial time for cardiac rehabilitation strategies after SCI may be within the first six months, warranting further investigation on cardiac function during this period.

Clinical Monitoring

Clinicians should be aware that many individuals with cervical SCI experience arrhythmias like bradycardia, SA node arrest, and SVT within the first month after SCI.

Further Research

A larger study is needed to provide insight into how the heart adapts to diminished sympathetic innervation and the characteristics of cardiovascular instability for each injury level resulting from acute traumatic SCI.

Study Limitations

1
Small number of participants in the thoracic group reduces power for comparison.
2
Large difference in age between the cervical and thoracic groups.
3
Possibility of missing significant events between the end of the first month and six months.

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