Prevalence and characterization of ECG abnormalities after intracerebral hemorrhage.
BACKGROUND
Although electrocardiographic (ECG) abnormalities are well known in ischemic stroke and subarachnoid hemorrhage, these changes have only rarely been investigated systematically in patients with intracerebral hemorrhage (ICH). The purpose of this study is to investigate the prevalence and type of ECG abnormalities in a consecutive series of ICH patients, and their possible association with pre-defined neurological and radiological parameters.


METHODS
The study population consisted of all consecutive patients with non-traumatic, intraparenchymal ICH admitted to the Academic Medical Center (AMC) between January 1, 2007 and October 1, 2007. Baseline information was prospectively registered in the AMC Stroke Register. ECGs obtained within 2 days after the initial hemorrhage were analyzed by one blinded observer. Admission cranial CT scans were re-analyzed by two blinded observers.


RESULTS
Thirty-one patients were included. Twenty-five patients (81%) had one or more ECG abnormalities. The most frequently observed ECG abnormality was QTc prolongation (36%), followed by ST-T morphologic changes (23%), sinus bradycardia (16%), and inverted T wave (16%). No patient was initially misdiagnosed for having myocardial ischemia. QTc prolongation was associated with ICH involvement of the insular cortex [OR 10.9 (95% CI 1.0-114.6)] and presence of intraventricular blood and hydrocephalus on admission CT scan [OR 10.8 (95% CI 1.6-70.9)].


CONCLUSIONS
In ICH patients ECG abnormalities are common. QTc prolongation seems associated with insular cortex involvement, with the presence of intraventricular blood, and with hydrocephalus. A larger cohort of continuously monitored ICH patients is necessary to investigate whether these ECG abnormalities are associated with poor outcome or death.
van Bree
Maurits D R
MD
Department of Neurology, Academic Medical Centre Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
Roos
Yvo B W E M
YB
van der Bilt
Ivo A C
IA
Wilde
Arthur A M
AA
Sprengers
Marieke E S
ME
de Gans
Koen
K
Vergouwen
Mervyn D I
MD
D000368:Aged; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000453:epidemiology*; D001919:Bradycardia / Q000175:diagnosis / Q000453:epidemiology; D002540:Cerebral Cortex / Q000503:physiopathology; D002543:Cerebral Hemorrhage / Q000175:diagnosis* / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D004562:Electrocardiography; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D006849:Hydrocephalus / Q000175:diagnosis / Q000453:epidemiology; D008133:Long QT Syndrome / Q000175:diagnosis / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012815:Signal Processing, Computer-Assisted; D013223:Statistics as Topic; D014057:Tomography, X-Ray Computed