[Permanent cardiac pacing in patients on chronic dialysis]
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H Kohno1, M Hisahara, M Umesue
1Department of Cardiovascular Surgery, Matsuyama Red Cross Hospital, Ehime, Japan.
Insights
Pacemaker implantation is safe for dialysis patients with bradyarrhythmia. Special attention is needed for elevated pacing thresholds during hemodialysis due to potential serum potassium changes.
Area of Science:
- Cardiology
- Nephrology
- Biomedical Engineering
Context:
- Chronic dialysis patients often require cardiac pacing for bradyarrhythmias like sick sinus syndrome or atrioventricular block.
- Permanent pacemaker implantation is a common procedure, but its implications in dialysis patients require specific consideration.
Purpose:
- To evaluate the sensing and pacing properties of pacemakers in patients undergoing chronic dialysis.
- To assess the safety and efficacy of physiological pacing modes (DDD, AAI) in this patient population.
Summary:
- This study reviewed four dialysis patients who received permanent pacemakers. Pacing parameters at implantation and long-term follow-up were comparable to non-dialysis patients.
- However, a significant increase in atrial pacing threshold was observed during hemodialysis in two patients, linked to decreased serum potassium levels.
Impact:
- Dialysis patients with significant bradyarrhythmia can be considered for pacemaker implantation similarly to non-dialysis patients.
- Clinicians must monitor for elevated pacing thresholds during hemodialysis in these patients, particularly when serum potassium levels fluctuate.
Abstract:
Four patients on chronic dialysis, who underwent permanent pacemaker implantation, were reviewed. The indication for pacing was sick sinus syndrome in three patients and complete atrioventricular block in one. Physiological pacing modes were chosen in all patients (DDD in three and AAI in one). Sensing and pacing properties in these patients studied at implantation and at follow-up (22-41 months after implantation) were similar as those in non-dialysis patients. However, the study of these properties during hemodialysis showed a significant elevation of atrial pacing threshold associated with marked decrease of serum potassium concentration in two patients. We conclude that dialysis patients with significant bradyarrhythmia should be considered for pacemaker implantation in the same manner as non-dialysis patients. However, special attention should be payed on the elevation of pacing threshold during hemodialysis.