The disparate effect of hemodialysis and hemodiafiltration on T-wave-peak-to-end interval (Tpe) and Tpe/QT ratio of the surface electrocardiogram

Abstract

Aim:The prolongation of T-wave-peak-to-end interval (Tpe) and arrhythmogenic index (AIX) could predict arrhythmias. Developing of ventricular arrhythmias is increased during hemodialysis (HD), but the effects of hemodiafiltration (HDF) on ventricular repolarization have not been elucidated yet.Methods: Thirty patients was investigated while they were receiving hemodiafiltration over a period of three months then the same group of patients was evaluated during treatment with hemodialysis for at least another three months. Ionic parameters, surface electrocardiograms (ECG), echocardiography, Holter ECGs were performed.Results: T-wave-peak-to-end interval and arrhythmogenic index significantly increased at the 240th minute of hemodialysis while did not change during hemodiafiltration. No malignant ventricular arrhythmias occurred, but number of ventricular premature beats was significantly higher during hemodialysis as compared to those during hemodiafiltration. Regarding hemodialysis a significant relationship was observed between the ratio of ventricular premature beats and arrhythmogenic index. Left ventricular mass index, septal-, posterior wall, inferior vena cava, left atrial diameters showed a positive correlation with T-wave-peakto-end interval only in the case of hemodialysis. A negative correlation occurred between the left ventricular ejection fraction, T-wave-peak-to-end interval and arrhythmogenic index, moreover between serum sodium and T-wave-peak-to-end interval, arrhythmogenic index during hemodialysis. Conclusions:Our results suggest that hemodialysis has unfavourable effect on the studied ECG parameters compared to hemodiafiltration.

Handling of Ventricular Fibrillation in the Emergency Setting

“…The physiological value of arrhythmogeneity index is approximately 0.19-0.2 (Zehir et al, 2015) and has proven to be even more precise than the corrected QT value in the prediction of torsades de pointes ventricular tachycardia and sudden cardiac death (Yamaguchi et al, 2003;Topilski et al, 2007;Wang et al, 2019). In another study the increase in Tpe and AIX were found to be significantly higher during hemodialysis compared to hemodiafiltration which indicates a pronounced risk for ventricular arrhythmia formation during the conventional renal replacement therapy (Páll et al, 2017). In a further investigation by Wang et al in patients with vasospastic angina pectoris, AIX had a sensitivity of 84% and a specificity of 89.5% in the prediction of malignant ventricular arrhythmias (Wang et al, 2019).…”