The Effects of a Single Dialysis Session on Atrial Electromechanical Conduction Times and Functions

Tekçe, Hikmet; Öztürk, Serkan; Aktas, Gülali; Tekçe, Buket Kın; Erdem, Alim; Özyaşar, Mehmet; Duman, Tuba Taslamacıoğlu; Yazıcı, Mehmet

doi:10.1159/000355742

Cited by 6 publications

(5 citation statements)

References 33 publications

(41 reference statements)

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“…Echocardiographic intra-atrial and interatrial activation times, for example, correlate with ultrafiltration volume and shorten significantly toward the end of HD (47). Similarly, there are peridialytic changes in P-wave dispersion (standard electrocardiography), P-wave duration, and the root mean square voltage of the final 20 ms of the filtered P wave (signal-averaged electrocardiography)-parameters that measure atrial conduction delay and are associated with AF (48,49).…”

Section: Dialysis As a Triggermentioning

confidence: 99%

Arrhythmia and Sudden Death in Hemodialysis Patients

Charytan

Foley

McCullough

et al. 2016

Clinical Journal of the American Society of Nephrology

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Background Dialysis patients have high rates of cardiovascular morbidity and mortality, but data on arrhythmia burden, arrhythmia type, arrhythmia triggers, and the identity of terminal arrhythmias have historically been limited by an inability to monitor heart rhythm for prolonged periods.Objectives To investigate arrhythmia and its association with sudden death in dialysis-dependent ESRD, describe the potential for implantable devices to advance study of dialysis physiology, review the ethical implications of using implantable devices in clinical studies, and report on the protocol and baseline results of the Monitoring in Dialysis Study (MiD).Design, setting, participants, & measurements In this multicenter, interventional-observational, prospective cohort study, we placed implantable loop recorders in patients undergoing long-term hemodialysis. The proportion of patients experiencing clinically significant arrhythmias was the primary endpoint. For 6 months, we captured detailed data on the primary endpoint, symptomatic arrhythmias, other electrocardiographic variables, dialysis prescription, electrolytes, dialysis-related variables, and vital signs. We collected additional electrocardiographic data for up to 1 year.Results Overall, 66 patients underwent implantation in sites in the United States and India. Diabetes was present in 63.6% of patients, 12.1% were age $70 years, 69.7% were men, and 53.0% were black. Primary and secondary endpoint data are expected in 2016.Conclusions Cardiac arrhythmia is an important contributor to cardiovascular morbidity and mortality in dialysis patients, but available technology has previously limited the ability to estimate its true burden and triggers and to define terminal rhythms in sudden death. Use of implantable technology in observational studies raises complex issues but may greatly expand understanding of dialysis physiology. The use of implantable loop recorders in MiD is among the first examples of such a trial, and the results are expected to provide novel insights into the nature of arrhythmia in hemodialysis patients.

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Section: Dialysis As a Triggermentioning

confidence: 99%

Arrhythmia and Sudden Death in Hemodialysis Patients

Charytan

Foley

McCullough

et al. 2016

Clinical Journal of the American Society of Nephrology

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“…Recently, several studies evaluating the effects of hemodialysis on atrial electromechanical functions as compared to healthy control group have been reported [ 23 , 24 , 25 ]. However, relationship of atrial electromechanical functions with AF attacks in hemodialysis patients has not been documented yet.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Atrial Electromechanical Delay to Predict Atrial Fibrillation in Hemodialysis Patients

et al. 2018

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Background and objective: Prevalence of atrial fibrillation is higher in hemodialysis patients as compared to the general population. Atrial electromechanical delay is known as a significant predictor of atrial fibrillation. In this study, we aimed to reveal the relationship between atrial electromechanical delay and attacks of atrial fibrillation. Materials and methods: The study included 77 hemodialysis patients over 18 years of age giving written consent to participate in the study. The patients were divided into two groups based on the results of 24-h Holter Electrocardiogram (Holter ECG) as the ones having attacks of atrial fibrillation and the others without any attack of atrial fibrillation. Standard echocardiographic measurements were taken from all patients. Additionally, atrial conduction times were measured by tissue Doppler technique and atrial electromechanical delays were calculated. Results: Intra- and interatrial electromechanical delay were found as significantly lengthened in the group of patients with attacks of atrial fibrillation (p = 0.03 and p < 0.001 respectively). The optimal cut-off time for interatrial electromechanical delay to predict atrial fibrillation was >21 ms with a specificity of 79.3% and a sensitivity of 73.7% (area under the curve 0.820; 95% confidence interval (CI), 0.716–0.898). In the multivariate logistic regression model, interatrial electromechanical delay (odds ratio = 1.230; 95% CI, 1.104–1.370; p < 0.001) and hypertension (odds ratio = 4.525; 95% CI, 1.042–19.651; p = 0.044) were also associated with atrial fibrillation after adjustment for variables found to be statistically significant in univariate analysis and correlated with interatrial electromechanical delay. Conclusions: Interatrial electromechanical delay is independently related with the attacks of atrial fibrillation detected on Holter ECG records in hemodialysis patients.

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“…In addition, the low-voltage areas were very close to the sinus of Valsalva and the AS-Ao. Tekce et al reported that even a single session of dialysis changed the LA diameter from 43.7 ± 5.3 mm (before HD) to 39.7 ± 4.6 mm (after HD) [ 6 ]. This result means that the stretching of the atrial myocytes occurred each time HD was performed, and the stretch itself has been proven to promote the LA remodeling.…”

Section: Discussionmentioning

confidence: 99%

A Case of Atrial Tachycardia Circulating around a Left Atrial Roof Scar with Diabetes Mellitus and Renal Failure on Hemodialysis

Hijioka

Kamioka

Suzuki

et al. 2016

Case Reports in Medicine

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Introduction. Little is known about the effects of volume change by hemodialysis (HD) and mechanical stress caused by an anatomical structure being in contact with the left atrium on the progression of atrial remodeling. We experienced a case of atrial tachycardia (AT) in a patient who had left atrial (LA) scarring at the LA roof and a low-voltage area with slow conduction around the LA scar as components of AT circuit. Here, we present the conceivable hypothesis of the LA scar and the low-voltage area formation. Our concept can be useful in developing a strategy for ablation in a patient with chronic renal failure (CRF) on HD. Case Report. A 65-year-old man with CRF on HD was referred for AT ablation. Three-dimensional electroanatomical mapping revealed that the AT conducted around an LA scar in a counterclockwise fashion. There was a slow conduction area at the superior side of the LA scar, where the AT was terminated during the ablation. Computed tomography indicated a close relationship between the LA and the anatomical structures (ascending aorta and pulmonary artery). Conclusion. Volume change by HD and close contact of anatomical structures to the LA can promote atrial remodeling, resulting in AT occurrence.

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The Effects of a Single Dialysis Session on Atrial Electromechanical Conduction Times and Functions

Cited by 6 publications

References 33 publications

Arrhythmia and Sudden Death in Hemodialysis Patients

Arrhythmia and Sudden Death in Hemodialysis Patients

Evaluation of Atrial Electromechanical Delay to Predict Atrial Fibrillation in Hemodialysis Patients

A Case of Atrial Tachycardia Circulating around a Left Atrial Roof Scar with Diabetes Mellitus and Renal Failure on Hemodialysis

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