Atrial fibrillation associated with autonomic dysreflexia in patients with tetraplegia

Abstract

Atrial fibrillation is an arrhythmia characterized by disorganized atrial depolarizations and an irregular ventricular response. Most patients with atrial fibrillation have underlying cardiac pathology. This paper presents the cases of three patients with high-level spinal cord injury and symptoms of autonomic dysreflexia who developed atrial fibrillation without any cardiac or metabolic disease that would predispose them to this. The paper proposes that autonomic dysreflexia might predispose a patient to atrial fibrillation by altering the pattern of repolarization of the atria, making the heart susceptible to a reentrant type of arrhythmia. High-level spinal cord injured patients may be at increased risk for the development of atrial fibrillation, an arrhythmia which, if left untreated, can increase the incidence of an embolic cerebrovascular accident that could further impair the patient's functional status.