Prolonged Sinus Arrest Following Traumatic Brain Injury: A Case of Reversible Neurocardiac Dysfunction

Neurocardiac dysfunction is a common effect seen in patients with Traumatic Brain Injury (TBI). Commonly these are associated with supraventricular arrhythmias and conduction disturbances. However, sinus arrest has rarely been presented in literature. A 37-year-old male presents after being assaulted including to the head. Upon arrival, the patient was intubated for airway protection. Imaging revealed acute, depressed, and comminuted right temporoparietal skull fracture(Figure 1), bilateral humeral head fractures, and posterior shoulder subluxation. The patient underwent a craniotomy and an External Ventricular Drain (EVD) was placed to monitor the intracranial pressure(ICP). The patient was admitted to the Intensive Care Unit where he was observed to have multiple episodes of sinus arrest lasting up to 15 seconds without having any metabolic or electrolyte abnormalities. A transvenous pacemaker(TVP) was placed to prevent additional episodes of sinus arrests. With improvement of ICP there was a corresponding cessation of these episodes and TVP was removed. TVP in this patient is primarily focused on preventing secondary brain injury by maintaining adequate cerebral perfusion through avoiding hypotension or hypoxia. Use of TVP should be individualized however further research must be done to clarify optimal management in these populations as there is limited literature regarding TBI and sinus arrest.