Risk of fatal sinus arrest induced by low-grade subarachnoid hemorrhage: A case of a young patient with obstructive sleep apnea

Abstract

Background: Sleep apnea syndrome (SAS) and subarachnoid hemorrhage (SAH) are both considered possible causes of secondary arrhythmias. However, there are limited reports on the increased risk of bradyarrhythmia for arrhythmia-free SAS patients with SAH.

Case description: A 31-year-old woman with SAS developed low-grade SAH and underwent coil embolization on postbleed day 1. Following a coiling procedure, she experienced worsening episodes of sinus arrest lasting up to 12 s and required a temporary pacemaker. Frequent episodes of sinus arrest were detected for the next 4 days. Thereafter, all types of arrhythmias gradually decreased, and she eventually recovered to be arrhythmia free.

Conclusion: Acceleration of sympathetic nervous activity caused by acute SAH may predispose patients to bradyarrhythmia with SAS and elicit asystole. The coexistence of SAS and SAH should be recognized as a cause of life-threatening sinus arrest, even if the severity of SAH is low grade.

Keywords: Endovascular surgery; Sinus arrest; Sleep apnea syndrome; Subarachnoid hemorrhage.

Figure 1:

Preoperative axial computed tomography (CT) (a) demonstrating subarachnoid haemorrhage. Three-dimensional reconstructed CT angiogram (b) showing a large internal carotid- posterior communicating artery aneurysm with a bleb (arrow).

Figure 2:

Electrocardiogram on admission.

Figure 3:

Preoperative (a) and postoperative (b) left internal carotid artery angiogram (frontal view). The low flow in the internal carotid-posterior communicating artery aneurysm (arrow) disappeared after endovascular treatment.

Figure 4:

Electrocardiogram in the intensive care unit showing bradycardia and repetitive transient severe asystole.