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Cardiac rhythm disturbances in children on hemodialysis
Emanuela Valsangiacomo1, Thomas J Neuhaus, Philippe Goetschel
1Division of Pediatric Cardiology, University Children's Hospital, Steinwiesstrasse 75, 8032 Zurich, Switzerland.
Insights
Pediatric hemodialysis patients rarely experience significant rhythm disturbances. Slow monomorphic ventricular tachycardias were observed, but overall cardiac electrical function appears preserved in children undergoing hemodialysis.
Area of Science:
- Pediatric Nephrology
- Cardiology
- Clinical Electrophysiology
Background:
- Cardiovascular complications are a major concern in adult dialysis patients.
- The cardiovascular health, particularly rhythm disturbances, in pediatric hemodialysis patients requires further investigation.
Purpose of the Study:
- To evaluate the cardiovascular system in children undergoing hemodialysis (HD).
- To specifically assess for rhythm disturbances in this pediatric population.
Main Methods:
- Nine pediatric patients (mean age 15.6 years) on HD underwent comprehensive cardiovascular assessments.
- Methods included 12-lead ECG, Holter-ECG, QT dispersion, signal-averaged ECG, exercise testing, echocardiography, and 24-h blood pressure monitoring.
Main Results:
- Most tests, including 12-lead ECG, exercise testing, QT dispersion, and signal-averaged ECG, yielded normal results.
- Holter-ECG revealed short runs of slow monomorphic ventricular tachycardia in two patients.
- Echocardiography showed ventricular hypertrophy in two patients; otherwise, it was normal.
Conclusions:
- Rhythm disturbances are infrequent in children on hemodialysis.
- Slow monomorphic ventricular tachycardias represent the primary significant finding.
- Preserved myocardial electrical excitability and recovery are suggested by normal QT dispersion and absence of late potentials.
Abstract:
Cardiovascular complications are the leading causes of morbidity and mortality in adult dialysis patients. The aim of this study was to evaluate the cardiovascular system of children on hemodialysis (HD), with special focus on rhythm disturbances. Nine patients, aged 15.6+/-4.1 years, underwent electrocardiographic examination (ECG) including 12-lead ECG, Holter-ECG, QT dispersion, signal-averaged ECG, and exercise testing. Echocardiography and 24-h blood pressure measurement were also performed. Patients had been on HD for a median period of 7 months (range 1-29 months). Normal findings were obtained with 12-lead ECG, exercise testing, QT dispersion, and signal-averaged ECG. Holter-ECG showed short runs of slow monomorphic ventricular tachycardia in two patients. Echocardiography was normal except for ventricular hypertrophy in two patients. In conclusion, rhythm disturbances were rare, with slow monomorphic ventricular tachycardias being the only significant finding. The absence of late potentials and normal QT dispersion suggest that myocardial electrical excitability and recovery are preserved in children on HD.