Effect of kidney transplantation on heart conduction disturbances in children treated with chronic hemodialysis – A pilot study

Abstract

Aim of the study was to assess the effect of KT on heart conduction in HD children. Non-invasive electrocardiographic method of BSPM was used. Isochrone maps, presenting a VAT distribution, were taken from eight HD patients and 26 normal subjects. Patients were divided into two groups: I--three children were HD <12 months prior to KT; II--five children were HD >12 months prior to KT. After KT, the groups were marked as IP and IIP. Serum iPTH and phosphate levels were significantly higher in both HD groups than in controls, with a considerable normalization after transplantation. HD patients demonstrated neither conduction abnormalities on ECG nor left ventricular hypertrophy. Group-mean VAT maps revealed: I and II--similar patterns of complete LBBB; IP--partial normalization to a pattern of anterior fascicle block; IIP--preserved pattern of LBBB. Intraventricular conduction disturbances found in HD children using BSPM were alleviated by KT. Short HD therapy increases a chance of conduction disturbances regression after KT, contrary to the longer HD treatment. BSPM is more sensitive than standard ECG in detecting heart conduction impairments in the HD patients.

Combined Cardiac Impairments in End-Stage Renal Disease

“…Our findings [2, 3] suggest that disturbances of the intraventricular conduction system observed in children with ESRD can be a significant component of LVD, which inevitably leads to systolic left-ventricular dysfunction.…”

“…Regarding cardiac impairments in such patients, we would like to draw attention to our findings [2, 3] showing intraventricular conduction disturbances in ESRD children in whom no abnormalities were observed on 12-lead electrocardiographic and echocardiographic examinations. In our study, a noninvasive multielectrode (87-lead) body surface potential mapping system (Fukuda Denshi Co Ltd, Tokyo, Japan) was applied to create isochrone maps to precisely reflect a sequence of ventricular activation time (i.e., VAT maps).…”

“…In our ESRD children treated conservatively [2] or with renal replacement [3], abnormal maps with delayed VAT values were noted, indicating some perturbations within the intraventricular conduction pathway. Patients on hemodialysis for <1 year demonstrated VAT maps typical for left bundle branch block (LBBB), which was partially alleviated after renal transplantation, becoming left anterior fascicle block.…”

Effects of hemodialysis on ventricular activation time in children with end‐stage renal disease

“…The most common clinical presentation of cardiac impairments in the course of ESRD is probably the left ventricle hypertrophy . The recent reports, concerning dialyzed children, have revealed that systolic function of the left ventricle keeps intact only if there is no concomitant arterial hypertension, anemia, or heart failure …”

Cardiac dysfunction in pediatric patients on renal replacement therapy

“…In the examined CKD children treated conservatively [2] or with renal replacement [3], the maps showed a varied abnormal distribution of prolonged VAT values, which suggested obstacles in the intraventricular conduction pathway. In patients hemodialyzed up to 12 months, the pattern specific for left bundle branch block (LBBB) was found, and after renal transplantation essential alleviation occurred, with a transformation to the left anterior fascicle block pattern.…”