Cardiac Rhythm Disturbances in Hemodialysis Patients: Early Detection Using an Implantable Loop Recorder and Correlation With Biological and Dialysis Parameters
Frederic Sacher, Laurence Jesel, Claire Borni-Duval, Valerie De Precigout, Frédéric Lavainne, Jean-Philippe Bourdenx, Atman Haddj-Elmrabet, Bruno Seigneuric, Adrien Keller, Julien Ott, Helene Savel, Yahsou Delmas, Dorothée Bazin-Kara, Nicolas Klotz, Sylvain Ploux, Sébastien Buffler, Philippe Ritter, Virginie Rondeau, Pierre Bordachar, Claire Martin, Antoine Deplagne, Sylvain Reuter, Michel Haissaguerre, Jean-Baptiste Gourraud, Cécile Vigneau, Philippe Mabo, Philippe Maury, Thierry Hannedouche, Antoine Benard, Christian Combe, Frederic Sacher, Laurence Jesel, Claire Borni-Duval, Valerie De Precigout, Frédéric Lavainne, Jean-Philippe Bourdenx, Atman Haddj-Elmrabet, Bruno Seigneuric, Adrien Keller, Julien Ott, Helene Savel, Yahsou Delmas, Dorothée Bazin-Kara, Nicolas Klotz, Sylvain Ploux, Sébastien Buffler, Philippe Ritter, Virginie Rondeau, Pierre Bordachar, Claire Martin, Antoine Deplagne, Sylvain Reuter, Michel Haissaguerre, Jean-Baptiste Gourraud, Cécile Vigneau, Philippe Mabo, Philippe Maury, Thierry Hannedouche, Antoine Benard, Christian Combe
Abstract
Objectives: The aim of this study was to identify using implantable loop recorder (ILR) monitoring the mechanisms leading to sudden death (SD) in patients undergoing hemodialysis (HD).
Background: SD accounts for 11% to 25% of death in HD patients.
Methods: Continuous rhythm monitoring was performed using the remote monitoring capability of the ILR device in patients undergoing HD at 8 centers. Clinical, biological, and technical HD parameters were recorded and analyzed.
Results: Seventy-one patients (mean age 65 ± 9 years, 73% men) were included. Left ventricular ejection fraction was <50% in 16%. Twelve patients (17%) had histories of atrial fibrillation or flutter at inclusion. During a mean follow-up period of 21.3 ± 6.9 months, 16 patients died (14% patient-years), 7 (44%) of cardiovascular causes. Four SDs occurred, with progressive bradycardia followed by asystole. The incidence of patients presenting with significant conduction disorder and with ventricular arrhythmia was 14% and 9% patient-years, respectively. In multivariate survival frailty analyses, a higher risk for conduction disorder was associated with plasma potassium >5.0 mmol/l, bicarbonate <22 mmol/l, hemoglobin >11.5 g/dl, pre-HD systolic blood pressure >140 mm Hg, the longer interdialytic period, history of coronary artery disease, previous other arrhythmias, and diabetes mellitus. A higher risk for ventricular arrhythmia was associated with potassium <4.0 mmol/l, no antiarrhythmic drugs, and previous other arrhythmias. With ILR monitoring, de novo atrial fibrillation or flutter was diagnosed in 14 patients (20%).
Conclusions: ILR may be considered in HD patients prone to significant conduction disorders, ventricular arrhythmia, or atrial fibrillation or flutter to allow early identification and initiation of adequate treatment. Therapeutic strategies reducing serum potassium variability could decrease the rate of SD in these patients. (Implantable Loop Recorder in Hemodialysis Patients [RYTHMODIAL]; NCT01252823).
Keywords: hemodialysis; implantable loop recorder; sudden death.
Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Source: PubMed