Predictors of Ventricular Dysrhythmias in Neurology Intensive Care Unit Patients with Prolonged QTc.

Abstract

Acute neurological injury and several medications commonly administered in the Neuro ICU pose a risk of fatal cardiac dysrhythmias. The objective of this study is to identify the predictors of ventricular dysrhythmias in the Neuro ICU patients with prolonged QTc, thereby helping the clinicians make important treatment decisions. We performed a retrospective review of all consecutive adults admitted to the Neuro ICU from January 2015 to September 2015 with a QTc interval ≥ 450ms on electrocardiogram. A total of 170 patients with a mean age of 66years (SD ± 16) were included in the final analysis. Eighty-seven patients (51%) were women. Median duration of hospitalization was 9days (IQR 4-16). Most common primary diagnosis was ischemic stroke (38%) followed by cerebral hemorrhage (19%) and subarachnoid hemorrhage (8%). Mean QTc was 487ms (SD ± 35, range 450-659ms). There were 27 episodes (16%) of monomorphic non-sustained ventricular tachycardia and one episode of Torsades (1%). Three cardiac arrests (2%) were recorded, none resulting from ventricular dysrhythmias. In multivariate analysis, prolonged QTc ≥ 492ms (p = 0.0008), supratentorial acute ischemic stroke (p = 0.005), prolonged hospitalization (p = 0.03), and premature ventricular complexes on ECG (p = 0.047) were all independently associated with increased risk of ventricular dysrhythmias. In this group of patients with prolonged QTc in the Neuro ICU, we observed several episodes of non-sustained ventricular tachycardia and identified important risk factors associated with their occurrence. This knowledge is essential to inform clinical decisions.