Predictors of Arrhythmic Events Detected by Implantable Loop Recorders in Renal Transplant Candidates

Abstract

BackgroundThe recording of arrhythmic events (AE) in renal transplant candidates (RTCs) undergoing dialysis is limited by conventional electrocardiography. However, continuous cardiac rhythm monitoring seems to be more appropriate due to automatic detection of arrhythmia, but this method has not been used.ObjectiveWe aimed to investigate the incidence and predictors of AE in RTCs using an implantable loop recorder (ILR).MethodsA prospective observational study conducted from June 2009 to January 2011 included 100 consecutive ambulatory RTCs who underwent ILR and were followed-up for at least 1 year. Multivariate logistic regression was applied to define predictors of AE.ResultsDuring a mean follow-up of 424 ± 127 days, AE could be detected in 98% of patients, and 92% had more than one type of arrhythmia, with most considered potentially not serious. Sustained atrial tachycardia and atrial fibrillation occurred in 7% and 13% of patients, respectively, and bradyarrhythmia and non-sustained or sustained ventricular tachycardia (VT) occurred in 25% and 57%, respectively. There were 18 deaths, of which 7 were sudden cardiac events: 3 bradyarrhythmias, 1 ventricular fibrillation, 1 myocardial infarction, and 2 undetermined. The presence of a long QTc (odds ratio [OR] = 7.28; 95% confidence interval [CI], 2.01–26.35; p = 0.002), and the duration of the PR interval (OR = 1.05; 95% CI, 1.02–1.08; p < 0.001) were independently associated with bradyarrhythmias. Left ventricular dilatation (LVD) was independently associated with non-sustained VT (OR = 2.83; 95% CI, 1.01–7.96; p = 0.041).ConclusionsIn medium-term follow-up of RTCs, ILR helped detect a high incidence of AE, most of which did not have clinical relevance. The PR interval and presence of long QTc were predictive of bradyarrhythmias, whereas LVD was predictive of non-sustained VT.

Monitoring of arrhythmia and sudden death in a hemodialysis population: The CRASH-ILR Study

“…Silva and colleagues evaluated predictors of arrhythmic events in transplant candidates with ILRs and found that out of 18 deaths, 7 were sudden cardiac events: 3 bradyarrhythmias, 1 VF, 1 myocardial infarction, and 2 undetermined. [ 19 ] CRASH-ILR, with an even more prolonged period of monitoring and with attempts made to download data at every HD session, found asymptomatic episodes of significant bradyarrhythmia in 10% and that SCD accounted for 28% of all deaths, which is similar to that noted in previous USRDS studies.…”

Arrhythmia in hemodialysis patients and its relation to sudden death

“…Silva et al implanted 100 ILRs into Brazilian patients on dialysis who were being considered as future transplant candidates. 5 During a mean follow-up of 424 days there were 18 deaths, of which 7 were believed to be sudden cardiac deaths. Three events were associated with primary bradycardia, one with ventricular fibrillation, and one myocardial infarction without ventricular tachyarrhythmia.…”

Mapping Progress in Reducing Cardiovascular Risk with Kidney Disease

“…In a study of 100 patients on hemodialysis in Brazil with ICMs, there were seven SCDs during follow-up. Four of seven deaths were due to arrhythmias, one was due to VT/VF, and three were due to bradyarrhythmias (5). Among 50 patients on hemodialysis in Australia with ICMs, there were eight SCDsall were due to bradyarrhythmias (6).…”