Published Online
on July 22, 2004

A more recent version of this article appeared on September 1, 2004

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Submitted on June 3, 2004
Accepted on June 21, 2004

Cardiac Autonomic Derangement and Arrhythmias in Right-Sided Stroke With Insular Involvement

Furio Colivicchi MD, FESC^*; Andrea Bassi MD; Massimo Santini MD, FESC, FACC; and Carlo Caltagirone MD

From the Cardiovascular Department (F.C., M.S.), San Filippo Neri Hospital, Rome, Italy; the I.R.C.C.S., Santa Lucia Foundation (A.B., C.C.), Rome, Italy; and the Department of Neurology (C.C.), University of Rome "Tor Vergata," Rome, Italy.

^* To whom correspondence should be addressed. E-mail: furcol{at}rdn.it.

Background and Purpose--The insula of the right cerebral hemisphere may have a major role in cardiac autonomic control. This study was aimed at assessing the effects of acute right insular ischemic damage on heart rate variability (HRV) and arrhythmias.

Methods--Holter monitoring for 24 hours was performed in 103 consecutive patients with first-ever acute ischemic stroke. Time and frequency domain measures of HRV and arrhythmias were considered in all cases.

Results--Forty-nine patients (47.5%) had a right-sided infarction, whereas 54 (52.5%) had a left-sided infarction. Insular involvement was present in 33 patients with right-sided stroke (67.3%) and in 36 patients with left-sided stroke (66.6%). When compared with all other stroke patients, subjects with right-sided insular damage showed significantly lower values of the standard deviation of all normal-to-normal (SDNN) R wave to R wave (RR) intervals and of the root mean square of differences (rMSSD) of adjacent normal-to-normal RR intervals, and higher low-frequency/high-frequency ratio values (P<0.05). Right insular stroke was also associated with more complex arrhythmias than any other localization (P<0.05). Moreover, in the whole population of stroke patients, lower values of SDNN were associated with the presence of more frequent and complex arrhythmias.

Conclusions--These findings further support the notion that the right insula is implicated in the autonomic control of cardiac activity and that acute right insular damage may lead to a derangement of cardiac function with potential prognostic implications.

Key words: arrhythmia • heart rate • stroke, acute

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