Arrhythmia issues in patients with renal disease

Arrhythmia issues arise frequently in the renal disease population, spanning the spectrum from benign ectopy to sustained arrhythmias. Studies adding to our understanding of arrhythmias and advances in technology have revolutionized the way we deal with many arrhythmias. In dealing with ventricular tachyarrhythmias, risk stratification is important, class III antiarrhythmics are preferred medications, and implantable defibrillators have assumed a dominant role. Atrial fibrillation, the most common cardiac arrhythmia, presents the challenges of dosing and drug interactions in the renal disease population; established and evolving catheter ablation approaches are becoming increasingly important. Other supraventricular arrhythmias will occur in this population and will require management. Permanent pacemakers continue to have a significant role for bradyarrhythmias; newer modes and features allow tailoring of these devices to individual patients. In addition, newer types of pacemakers may allow for clinical improvement in heart failure patients. Appropriate handling of arrhythmias can enhance the survival and quality of life of patients with renal disease.