Cardiac Rhythm Disturbances in Hemodialysis Patients

Sacher, Frédéric; Jesel, Laurence; Borni-Duval, Claire; Précigout, V. De; Lavainne, Frédéric; Bourdenx, Jean-Philippe; Haddj-Elmrabet, Atman; Seigneuric, Bruno; Keller, Adrien; Ott, Julien; Savel, Hélène; Delmas, Yahsou; Bazin-Kara, Dorothée; Klotz, Nicolas; Ploux, Sylvain; Buffler, Sébastien; Ritter, Philippe; Rondeau, Virginie; Bordachar, Pierre; Martin, Claire; Deplagne, Antoine; Reuter, Sylvain; Haı̈ssaguerre, Michel; Gourraud, Jean‐Baptiste; Vigneau, Cécile; Mabo, Philippe; Maury, Philippe; Hannedouche, Thierry; Bénard, Antoine; Combe, Christian

doi:10.1016/j.jacep.2017.08.002

Cited by 49 publications

(27 citation statements)

References 32 publications

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“…One explanation for this result might be provided by recent studies showing that fatal arrhythmias are more frequently related to bradyarrhythmias than to tachyarrhythmias. Although ICDs also have a pacing capability, the brady-/tachyarrhythmia balance might still affect the ICD prophylaxis in hemodialysis patients (Roy-Chaudhury et al, 2018;Sacher et al, 2018;Genovesi et al, 2019). Another reason for the infectivity of ICD implantation in hemodialysis patients includes electrolyte imbalances which increases the risk of ineffective shock therapy.…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular Mortality Can Be Predicted by Heart Rate Turbulence in Hemodialysis Patients

et al. 2020

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Background: Excess mortality in hemodialysis patients is mostly of cardiovascular origin. We examined the association of heart rate turbulence (HRT), a marker of baroreflex sensitivity, with cardiovascular mortality in hemodialysis patients. Methods: A population of 290 prevalent hemodialysis patients was followed up for a median of 3 years. HRT categories 0 (both turbulence onset [TO] and slope [TS] normal), 1 (TO or TS abnormal), and 2 (both TO and TS abnormal) were obtained from 24 h Holter recordings. The primary end-point was cardiovascular mortality. Associations of HRT categories with the endpoints were analyzed by multivariable Cox regression models including HRT, age, albumin, and the improved Charlson Comorbidity Index for hemodialysis patients. Multivariable linear regression analysis identified factors associated with TO and TS. Results: During the follow-up period, 20 patients died from cardiovascular causes. In patients with HRT categories 0, 1 and 2, cardiovascular mortality was 1, 10, and 22%, respectively. HRT category 2 showed the strongest independent association with cardiovascular mortality with a hazard ratio of 19.3 (95% confidence interval: 3.69-92.03; P < 0.001). Age, calcium phosphate product, and smoking status were associated with TO and TS. Diabetes mellitus and diastolic blood pressure were only associated with TS.

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Section: Discussionmentioning

confidence: 99%

Cardiovascular Mortality Can Be Predicted by Heart Rate Turbulence in Hemodialysis Patients

et al. 2020

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“…Higher serum potassium (.5.0 mEq/L) was associated with bradyarrhythmias, and low serum potassium (,4.0 mEq/L) was associated with ventricular tachycardia. In addition, among 30 patients on hemodialysis in the United Kingdom with ICMs, there were two sudden deaths (one due to VT/VF), but bradyarrhythmias were common, and three patients required pacemakers (8). Finally, the Monitoring in Dialysis Study followed 66 patients on hemodialysis with ICMs in the United States and India (9).…”

Section: Recent Therapeutic Advancesmentioning

confidence: 99%

Mapping Progress in Reducing Cardiovascular Risk with Kidney Disease

Shafi

Güallar

2018

CJASN

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“…Since 2015, five studies using ILR in asymptomatic HD patients have been published (Silva et al, 2015; Wong M.C. et al, 2015; Roberts et al, 2017; Roy-Chaudhury et al, 2018; Sacher et al, 2018) (Table 1). Collectively, they included 317 prevalent HD patients with largely preserved left ventricular ejection fraction.…”

Section: Introductionmentioning

confidence: 99%

“…Collectively, they included 317 prevalent HD patients with largely preserved left ventricular ejection fraction. The age ranged from 56 ± 12 (Roy-Chaudhury et al, 2018) to 68 ± 12 (Roberts et al, 2017) years and follow up time ranged from 6 (Roy-Chaudhury et al, 2018) to 21 ± 7 (Sacher et al, 2018) months. In total, there were 52 deaths (15%) of which 21 (6.6% of patients, 40% of deaths) were classified as SCD.…”

Section: Introductionmentioning

confidence: 99%

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Sudden Cardiac Death in Dialysis: Arrhythmic Mechanisms and the Value of Non-invasive Electrophysiology

et al. 2019

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Sudden Cardiac Death (SCD) is the leading cause of cardiovascular death in dialysis patients. This review discusses potential underlying arrhythmic mechanisms of SCD in the dialysis population. It examines recent evidence from studies using implantable loop recorders and from electrophysiological studies in experimental animal models of chronic kidney disease. The review summarizes advances in the field of non-invasive electrophysiology for risk prediction in dialysis patients focusing on the predictive value of the QRS-T angle and of the assessments of autonomic imbalance by means of heart rate variability analysis. Future research directions in non-invasive electrophysiology are identified to advance the understanding of the arrhythmic mechanisms. A suggestion is made of incorporation of non-invasive electrophysiology procedures into clinical practice. Key Concepts : – Large prospective studies in dialysis patients with continuous ECG monitoring are required to clarify the underlying arrhythmic mechanisms of SCD in dialysis patients. – Obstructive sleep apnoea may be associated with brady-arrhythmias in dialysis patients. Studies are needed to elucidate the burden and impact of sleeping disorders on arrhythmic complications in dialysis patients. – The QRS-T angle has the potential to be used as a descriptor of uremic cardiomyopathy. – The QRS-T angle can be calculated from routine collected surface ECGs. Multicenter collaboration is required to establish best methodological approach and normal values. – Heart Rate Variability provides indirect assessment of cardiac modulation that may be relevant for cardiac risk prediction in dialysis patients. Short-term recordings with autonomic provocations are likely to overcome the limitations of out of hospital 24-h recordings and should be prospectively assessed.

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Cardiac Rhythm Disturbances in Hemodialysis Patients

Cited by 49 publications

References 32 publications

Cardiovascular Mortality Can Be Predicted by Heart Rate Turbulence in Hemodialysis Patients

Cardiovascular Mortality Can Be Predicted by Heart Rate Turbulence in Hemodialysis Patients

Mapping Progress in Reducing Cardiovascular Risk with Kidney Disease

Sudden Cardiac Death in Dialysis: Arrhythmic Mechanisms and the Value of Non-invasive Electrophysiology

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