J Neurocrit Care.  2018 Jun;11(1):7-12. 10.18700/jnc.180050.

Management of Common Arrhythmia in the Neurological Intensive Care Unit

• Kim SH

• KMID: 2426208
• DOI: http://doi.org/10.18700/jnc.180050

Abstract

Cardiac arrhythmias are a common problem in the neurological intensive care unit and represent a major cause of ischemic stroke. Significant arrhythmias are most likely to occur in elderly patients. In this review, we focus on three arrhythmias: premature beats, atrial fibrillation, and QT prolongation. The goal of this review is to provide a current concept of diagnosis and acute management of arrhythmias in the neurological intensive care unit.

Keyword

Atrial premature complexes; Ventricular premature complexes; Atrial fibrillation

MeSH Terms

Aged
Arrhythmias, Cardiac*
Atrial Fibrillation
Atrial Premature Complexes
Cardiac Complexes, Premature
Critical Care*
Diagnosis
Humans
Intensive Care Units*
Stroke
Ventricular Premature Complexes

Figure

• 

  Figure 1. Classification of arrhythmias. Arrhythmias can first be classified by ventricular rate. PAC, premature atrial contraction; AF, atrial fibrillation; AT, atrial tachycardia; AFL, atrial flutter; PSVT, paroxysmal supraventricular tachycardia; PVC, premature ventricular contraction; VT, ventricular tachycardia; VF, ventricular fibrillation; VFL, ventricular flutter.

• 

  Figure 2. Electrocardiographic findings of premature beats and atrial fibrillation. (A) Red arrow indicates positive P wave in lead II, which is compatible with normal sinus rhythm. (B) Blue arrow indicates normal T wave, but the T wave, which the red arrow indicates, looks different, which means an ectopic P wave is superimposed on the T wave, i.e., premature atrial contraction. (C) Red arrow indicates a QRS wave with different morphology, which occurs in unexpected premature timing. Large R wave in lead II suggests that the ventricular outflow tract is the origin of premature ventricular contractions. (D) No discrete P wave and irregularly irregular QRS wave, which indicate atrial fibrillation.

• 

  Figure 3. QT interval and its correction as heart rate (HR). (A) Usually, normal QT Intervals are less than half the RR Interval for heart rates below 100 bpm. (B) Electrocardiography machine provides QT interval and corrected QT interval (QTc). The measurement of QT interval by the machine is usually incorrect, but RR interval and 1/√RR are precise. Therefore, QT interval should be measured manually and 1/√RR could be found by simple calculation.

• 

  Figure 4. Electrocardiographic findings of premature ventricular contractions from right ventricular outflow tract. In leads II and III, aVF, a large R wave was shown (red arrow). In the V1, the QRS morphology of a premature ventricular contraction is mainly negative (red arrow).

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