Autonomic consequences of cerebral hemisphere infarction.

Background And Purpose: Recently, supraventricular tachycardia has been reported following right hemisphere stroke, suggesting a reduction in parasympathetic cardiac innervation after stroke of the right hemisphere. We performed power spectrum analysis of fluctuations in RR interval duration in the electrocardiogram in an attempt to determine how ischemic stroke influences autonomic cardiac innervation.

Methods: Power spectrum analysis of the variation in 256 consecutive electrocardiographic RR intervals was performed using the fast-Fourier transformation. The area under the spectral curve from 0 to 0.5 Hz and the area under the portion of the curve produced by parasympathetically mediated respiratory variations were determined in 20 patients with right-hemisphere and 20 patients with left-hemisphere ischemic stroke confirmed by computerized tomography. Data were compared with 40 age- and sex-matched healthy controls.

Results: Total cardiac autonomic innervation was reduced after a stroke of either hemisphere without regard to laterality. Cardiac parasympathetic innervation was reduced after stroke of either hemisphere with a significantly greater reduction after stroke on the right (P = 2.9 x 10(-5).

Conclusions: Power spectral analysis of heart rate variability can detect autonomic consequences of stroke. The spectral data predict that, to the degree that cardiac arrhythmia is produced by unbalanced cardiac autonomic activity favoring the sympathetic system, such arrhythmias could be seen after stroke of either hemisphere and would be more common after cerebral infarction on the right. This is consistent with evidence from the recent literature.