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Cardiac Rhythm Disturbances in Hemodialysis Patients

Frédéric Sacher 1 Laurence Jesel 2 Claire Borni-Duval Valerie de Precigout Frédéric Lavainne 3 Jean-Philippe Bourdenx Atman Haddj-Elmrabet Bruno Seigneuric 4 Adrien Keller Julien Ott 5 Hélène Savel 6 Yahsou Delmas 7 Dorothée Bazin-Kara Nicolas Klotz 1 Sylvain Ploux 8 Sébastien Buffler Philippe Ritter 9 Virginie Rondeau 10 Pierre Bordachar 11 Claire Martin 12 Antoine Deplagne 13 Sylvain Reuter Michel Haïssaguerre 1 Jean-Baptiste Gourraud 14, 15 Cécile Vigneau 16, 17 Philippe Mabo 18 Philippe Maury 19 Thierry Hannedouche 20 Antoine Bénard 21 Christian Combe 11
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).
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Submitted on : Monday, January 20, 2020 - 10:55:14 AM
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Frédéric Sacher, Laurence Jesel, Claire Borni-Duval, Valerie de Precigout, Frédéric Lavainne, et al.. Cardiac Rhythm Disturbances in Hemodialysis Patients. JACC: Clinical Electrophysiology, Elsevier, 2018, 4 (3), pp.397-408. ⟨10.1016/j.jacep.2017.08.002⟩. ⟨hal-02445406⟩

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