Spontaneous Subarachnoid Hemorrhage and the Heart: The Silent Threat to Atrial Electrical Activity

Background: Spontaneous subarachnoid hemorrhage has been associated with significant cardiovascular changes, including alterations in atrial electrical activity. This study investigates the impact of SAH on atrial function using P wave dispersion (PWD) as an electrocardiographic marker. Methods: This retrospective study included 131 individuals (50 SAH patients and 81 healthy controls) admitted to Ümraniye Training and Research Hospital. Standard 12-lead electrocardiography (ECG) was used to measure P wave dispersion (PWD), defined as the difference between the maximum (Pmax) and minimum (Pmin) P wave durations. Statistical analyses were performed using SPSS version 25.0, with comparisons between groups made using the Mann-Whitney U test and Chi-Square test where applicable. Results: The mean P wave dispersion was significantly higher in the SAH group (1.03 ± 0.5) compared to the control group (0.63 ± 0.23, p < 0.001). Additionally, ST segment elevation was observed in 5 SAH patients, while 10 showed T wave inversions and 3 had prolonged QT intervals. However, no significant troponin elevation was noted, suggesting an SAH-induced ECG alteration rather than acute myocardial infarction. Postoperatively, 30 patients exhibited no cardiac complications, while 11 had hypertension, 2 had tachycardia, 1 had bradycardia, 1 had ST elevation, and 1 developed pericardial effusion. Transient atrial fibrillation was observed in four patients, and normal sinus rhythm was restored with medical treatment. Conclusion: The findings suggest that SAH is associated with significant disruptions in atrial electrical activity, as evidenced by increased P wave dispersion. Prolonged PWD may indicate an elevated risk of atrial fibrillation, contributing to further neurological deterioration. Understanding the cardiac implications of SAH is crucial for early intervention and improved patient outcomes.