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Pain and Spine Medicine

Recurrent Bradycardia-Induced Cardiac Arrest in a Patient with Non-Traumatic Tetraplegia: A Case Report

Friday, October 24, 2025
12:00 PM - 1:30 PM MT
Location: Kiosk 4
Has Audio

    Poster Presenter(s)

  • Kristin Geczi, MD (she/her/hers)

    Resident Physician
    University of Louisville School of Medicine PM&R Program
    Louisville, Kentucky

    • Co-Author(s)

  • ZD

    Zakari Dymock, MD

    Spinal Cord injury Fellow
    University of Louisville, Division of PM&R
    Lexington, Kentucky

  • Camilo Castillo, MD

    Program Director, Associate Professor
    University of Louisville
    Louisville, Kentucky

Disclosure(s):
Kristin Geczi, MD: No financial relationships to disclose
Camilo Castillo, MD: No relevant disclosure to display
Case Diagnosis: A 58-year-old male with C2 AIS A spinal cord injury (SCI) due to acute cord infarction had bradycardia-induced recurrent cardiac arrests

Case Description or Program Description: A C2 AIS A, motor complete tetraplegia due to extensive spinal cord edema at the C2-C3 and C7-T1 levels, consistent with acute cord infarction, experienced recurrent episodes of bradycardia during his initial course, which were attributed to vagal responses by cardiology. The patient suffered cardiac arrest, presumed to be secondary to hypoxia, and was subsequently transferred to long-term acute care (LTAC) for ventilator weaning. Eight weeks post-injury, he experienced a second cardiac arrest in LTAC, which was attributed to mucus plugging. He was then discharged for acute inpatient rehabilitation (AIR). Ten weeks post-injury, he continued to experience persistent bradycardia, with heart rates falling into the 40s. During the following 10 days in acute care, he experienced three additional cardiac arrests triggered by episodes of severe bradycardia.

Setting: Inpatient Academic Rehab Hospital

Assessment/Results: Electrophysiology was consulted for a pacemaker placement following five episodes of cardiac arrest. A leadless pacemaker was successfully implanted 12 weeks post-injury, resolving his symptoms. The patient was transferred back to AIR and later discharged home with family.

Discussion (relevance): Bradycardia occurs in 64–77% of tetraplegics, peaking 2–6 weeks post-injury, and usually resolves within the first 2–6 weeks after SCI. Cardiac arrest is extremely rare in these cases.

Conclusions: Prompt recognition and management of cardiovascular complications after SCI reduces morbidity and mortality, enhancing quality of life.