Stroke and ventricular arrhythmias

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.