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Cardiac arrhythmias in patients on maintenance hemodialysis
Insights
Potentially dangerous ventricular premature beats (VPB) were rare in hemodialysis patients. Higher-grade VPB occurred mainly in those with existing heart disease or digoxin toxicity, often during or after dialysis.
Area of Science:
- Nephrology
- Cardiology
- Clinical Electrophysiology
Background:
- Maintenance hemodialysis patients are at risk for cardiac complications.
- Cardiac arrhythmias can be a concern during or after dialysis sessions.
Purpose of the Study:
- To investigate the occurrence and characteristics of cardiac arrhythmias, specifically ventricular premature beats (VPB), in patients undergoing maintenance hemodialysis.
- To identify potential risk factors associated with dangerous VPB in this population.
Main Methods:
- Ambulatory electrocardiographic monitoring was used to assess cardiac arrhythmias in 17 patients on maintenance hemodialysis.
- Serum digoxin concentrations were monitored.
- Patients' medical history, including pre-existing cardiac conditions and risk factors, was reviewed.
Main Results:
- Most patients (14/17) had absent or low-grade ventricular premature beats (VPB) that did not increase during dialysis.
- Three patients experienced potentially dangerous, higher-grade VPB (multiform, salvos, R on T).
- These higher-grade VPB occurred in 2 patients during or after dialysis and were associated with pre-existing severe cardiac disease and/or digoxin toxicity.
Conclusions:
- Potentially dangerous ventricular premature beats (VPB) are uncommon in patients on maintenance hemodialysis.
- The occurrence of significant VPB appears primarily linked to pre-existing cardiac conditions and/or overdigitalization, rather than routine hemodialysis itself.
- Standard risk factors like age, hypertension, and electrolyte changes did not appear to be significant predictors of VPB in this cohort.
Abstract:
17 patients on maintenance hemodialysis were monitored for cardiac arrhythmias using ambulatory electrocardiographic recording. Atrioventricular dissociation was found in a patient with an elevated serum digoxin concentration, intradialytic supraventricular tachycardia had been present in a second patient during acute uremic pericarditis prior to the study. Ventricular premature beats (VPB) were absent or of low grade (occasional/uniform) in 14 patients and did not increase on dialysis. 3 patients had potentially dangerous VPB of higher grades (multiform, salvos or R on T) which occurred on or after dialysis in 2. 2 of these 3 patients were overdigitalized, and 2 had severe cardiac disease (amyloid, old myocardial infarction). Several other risk factors (age, hypertension, cardiac hypertrophy, smoking, hyperlipidemia, electrolyte changes) did not seem to be of importance for VPB. In these patients on maintenance hemodialysis, potentially dangerous VPB were rare and occurred mainly during or after dialysis in patients with preexisting heart disease and/or digitalization.