title: Evaluation of the Effect of Aneurysmal Clipping on Electrocardiography and Echocardiographic Changes in Patients With Subarachnoid Hemorrhage: A Prospective Observational Study.
abstract: BACKGROUND
  Electrocardiographic (ECG) and echocardiographic changes that are subsequent to aneurysmal subarachnoid hemorrhage (a-SAH) are commonly observed with a prevalence varying from 27% to 100% and 13% to 18%, respectively. There are sparse data in the literature about the pattern of ECG and echocardiographic changes in patients with SAH after clipping of the aneurysm. Hence, we observed the effect of aneurysmal clipping on ECG and echocardiographic changes during the first week after surgery, and the impact of these changes on outcome at the end of 1 year.
  
  
  METHODS
  This prospective, observational study was conducted in 100 consecutive patients with a-SAH undergoing clipping of ruptured aneurysm. ECG and echocardiographic changes were recorded preoperatively and every day after surgery until 7 days. Outcome was evaluated using the Glasgow outcome scale at the end of 1 year.
  
  
  RESULTS
  Of 100 patients, 75 had ECG changes and 17 had echocardiographic changes preoperatively. The ECG changes observed were QTc prolongation, conduction defects, ST-wave and T-wave abnormalities, tachyarrhythmias, and bradyarrhythmias. The echocardiography changes included global hypokinesia and regional wall motion abnormalities. Both echocardiographic and ECG changes showed significant recovery on the first postoperative day. Patients presenting with both echocardiographic and ECG changes were found to require higher ionotropic support to maintain the desired blood pressure, and were associated with poor outcome (Glasgow outcome scale, 1 to 2) at 1 year after surgery. There was no association of ECG and echocardiographic changes with mortality (both in-hospital or at 1 year).
  
  
  CONCLUSIONS
  The ECG changes, such as QTc prolongation, bradycardia, conduction abnormality, and echocardiographic changes, recover on postoperative day-1, in most of the cases after clipping. Patients with combined ECG and echocardiographic changes tend to have poor neurological outcome at the end of 1 year.
authors.affiliation: Departments of *Anaesthesia and Intensive Care †Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Kiran
authors.initials: K
authors.lastname: Jangra
authors.forename: Vinod K
authors.initials: VK
authors.lastname: Grover
authors.forename: Hemant
authors.initials: H
authors.lastname: Bhagat
authors.forename: Avanish
authors.initials: A
authors.lastname: Bhardwaj
authors.forename: Manoj K
authors.initials: MK
authors.lastname: Tewari
authors.forename: Bhupesh
authors.initials: B
authors.lastname: Kumar
authors.forename: Nidhi B
authors.initials: NB
authors.lastname: Panda
authors.forename: Seelora
authors.initials: S
authors.lastname: Sahu
mesh_terms: D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000503:physiopathology; D001794:Blood Pressure; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D023261:Glasgow Outcome Scale; D006329:Heart Conduction System; D006801:Humans; D008133:Long QT Syndrome / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D011446:Prospective Studies; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*