Cardiac pacemaker in high spinal cord injury

Bradycardia followed by cardiac arrest is well documented as a complication of acute injury to the cervical spinal cord. This life-threatening bradycardia is attributed to an imbalance in the autonomic nervous system resulting from dissociation of the parasympathetic from the sympathetic responses during the stage of spinal shock. A patient with a C2 complete quadriplegia secondary to birth trauma who experienced symptomatic bradycardia, continuing for 21 months after injury despite intensive medical management, is reported. Clinical improvement followed insertion of a cardiac pacemaker. Possible etiologies for the continuation of abnormal bradycardia episodes after the resolution of spinal shock are discussed. Cardiac pacemaker implantation is advocated for patients with high cervical spinal cord injuries and continuing symptomatic bradycardia not responding to medical measures.