Cardiovascular Medicine, Vol. 29, Pages 6: Prolonged Sinus Arrest Following Traumatic Brain Injury: A Case of Reversible Autonomic Cardiac Dysfunction

Cardiovascular Medicine doi: 10.3390/cardiovascmed29010006

Authors:
Krishna Patel
Chris Sani
Asher Gorantla
Varshitha T. Panduranga
Usaid Raqeeb
Adam Budzikowski

Cardiac disturbances are well-recognized in traumatic brain injury (TBI), but most involve supraventricular arrhythmias or repolarization abnormalities, while sinus arrest is rarely reported. We present a case of a 37-year-old man who developed recurrent, prolonged sinus arrest following severe TBI. He arrived intubated for airway protection after an assault, and imaging demonstrated an acute, depressed, comminuted right temporoparietal skull fracture scattered subarachnoid hemorrhage, and bilateral humeral head fractures with posterior shoulder subluxation. After craniotomy and placement of an external ventricular drain (EVD) for intracranial pressure (ICP) monitoring, the patient experienced multiple spontaneous sinus arrest episodes lasting up to 15 s despite normal metabolic, electrolyte, and toxicology evaluations. A transvenous pacemaker (TVP) was inserted to maintain adequate cardiac output and cerebral perfusion. As ICP improved, the sinus arrests resolved and the TVP was removed. This case highlights a rare neurocardiac manifestation of TBI, demonstrating that elevated ICP can precipitate profound conduction disturbances that may require temporary pacing to manage hemodynamics and prevent secondary brain injury.

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Krishna Patel www.mdpi.com