Hemodialysis-Induced Left Ventricular Dysfunction Is Associated with an Increase in Ventricular Arrhythmias

Abstract

Conventional hemodialysis results in intradialytic cardiac ischemia in a significant proportion of patients. Segmental myocardial ischemia results in the development of left ventricular regional wall motion abnormalities. Sudden death is the most common cause of mortality in hemodialysis patients. This study looked to examine any association between the development of left ventricular regional wall motion and cardiac arrhythmias. Forty established hemodialysis patients had 24-hour Holter recordings, which commenced immediately before a dialysis session. Frequency of isolated ectopy was classified as a percentage of the total beats on the Holter monitor record. Ventricular arrhythmias were stratified according to the Lown classification. Classes 3 and above were taken as complex ventricular arrhythmias. Patients also underwent baseline and intradialytic echocardiography to assess the development of concurrent regional wall motion abnormalities. Premature ventricular complexes and complex ventricular arrhythmias were both more common during hemodialysis than in the subsequent monitored period. Patients who developed regional wall motion abnormalities (n = 27) had significantly more premature ventricular complexes during hemodialysis than afterward ( p < 0.001). Patients with ischemic heart disease and left ventricular hypertrophy both had a higher frequency of premature ventricular complexes during hemodialysis than those without ( p < 0.03 and p < 0.02, respectively).Cardiac arrhythmias are common in hemodialysis patients. The frequency of premature ventricular complexes is significantly higher during hemodialysis in patients who develop regional wall motion abnormalities and may be related to factors associated with demand ischemia.

Cyclohexanone contamination from extracorporeal circuits impairs cardiovascular function

“…Data from the present study 1) provide a current estimate of CHX contamination in commercially available IV bags and EC circuits and 2) clearly indicate that the effects of 210 g/l IV CHX (a concentration that conservatively approximates clinical exposure for EC patients) mirror the cardiovascular morbidities associated with EC: bradycardia/dysrhythmia (1,4,5,19,33,38), depressed ventricular contractility (1,2,4,5,8,11,18,19,24,33,38,39,41), low cardiac output (7,11,14,28,31), high systemic and pulmonary vascular resistance (7, 13, 18, 29 -31), hypotension/labile blood pressure (2,7,21), pulmonary hypertension (7, 29 -31), impaired neurological (baroreflex) function (3,5,34,38,39), and edema formation (20,32,39).…”

Pediatric Myocardial Stunning Underscores the Cardiac Toxicity of Conventional Hemodialysis Treatments

“…We found no significant association between these aforementioned risk factors and the severity of myocardial stunning, possibly because cardiorenal performance is influenced by a number of humoral and genetic factors (26) that act collectively to exert an effect but in isolation, particularly in pediatrics, are too small to be detectable from our sample size. The major determinant of intradialytic BP is cardiac output and end diastolic volume (27), but clearly regional LV function is important as evidenced by reports of reduced hemodynamic stability in patients developing myocardial stunning despite below average UF volumes (13). Shoji et al (28) found BP reduction during dialysis and not hypertension in adult HD patients as a factor that influenced survival negatively.…”

“…Hibernation in turn contributes to congestive heart failure (11) and has been shown to be marker of poor prognosis (12). Within the renal HD cohort, transient myocardial ischemia precipitated cardiac arrhythmias (13), regional fixed systolic dysfunction, and reduced overall systolic function (2).…”

Acute Complications of Hemodialysis

“…Another two types of arrhythmia, the complex ventricular arrhythmia and premature ventricular complexes, in particular increase the mortality and morbidity. Complex ventricular arrs (those defined as having a Lown score of 3 and more) prevail at a rate of 35% in the HD patient group (Burton et al,2008).…”