Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada.
Int J Cardiol. 2013 Sep 30;168(2):653-9. doi: 10.1016/j.ijcard.2013.03.058. Epub 2013 Apr 17.
Electrocardiographic abnormalities and cardiac arrhythmias are commonly noted after acute stroke. Risk of malignant ventricular arrhythmias is increased after a stroke and is associated with sudden cardiac death. Autonomic imbalance modulated by direct injury to neurogenic structures and enhanced by catecholamine storm can lead to myocardial damage and arrhythmogenesis. Experimental and clinical evidence suggests that insular cortex infarcts play a key role in autonomic dysregulation that lead to arrhythmias in the acute setting. Management of ventricular arrhythmias associated with acute stroke should focus on continuous cardiac monitoring, drug therapy, and electrolyte correction. Further research is needed to identify neurological structures involved in autonomic control and risk factors for ventricular arrhythmogenesis after acute stroke.
急性脑卒中后常可观察到心电图异常和心律失常。脑卒中后恶性室性心律失常的风险增加，并与心源性猝死相关。神经原性结构的直接损伤和儿茶酚胺风暴的增强调节自主平衡，导致心肌损伤和心律失常发生。实验和临床证据表明，岛叶皮质梗死在自主神经功能紊乱中起关键作用，导致急性脑卒中时发生心律失常。急性脑卒中相关室性心律失常的治疗应侧重于持续心脏监测、药物治疗和电解质纠正。需要进一步研究以确定参与自主控制的神经结构和急性脑卒中后室性心律失常发生的危险因素。
