Effect of haemodialysis on signal-averaged electrocardiogram P-wave parameters

Jaroszyński, Andrzej; Główniak, Andrzej; Sodolski, T.; Załuska, Wojciech; Widomska-Czekajska, T; Książek, Andrzej

doi:10.1093/ndt/gfi175

Cited by 12 publications

(17 citation statements)

References 19 publications

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“…In others, changes were not detected or were seen only at the conclusion of dialysis and then quickly attenuated (52). However, in one study, P-wave duration decreased and root mean square voltage of the final 20 ms of the filtered P wave decreased from the beginning to the end of dialysis, changes suggesting a reduced risk of AF after HD (53). Changes in electrolytes were associated with P-wave parameters in several studies (51,52), but associations with ultrafiltration appear more robust (50,51).…”

Section: Dialysis As a Triggermentioning

confidence: 94%

Arrhythmia and Sudden Death in Hemodialysis Patients

Charytan

Foley

McCullough

et al. 2016

Clinical Journal of the American Society of Nephrology

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Background Dialysis patients have high rates of cardiovascular morbidity and mortality, but data on arrhythmia burden, arrhythmia type, arrhythmia triggers, and the identity of terminal arrhythmias have historically been limited by an inability to monitor heart rhythm for prolonged periods.Objectives To investigate arrhythmia and its association with sudden death in dialysis-dependent ESRD, describe the potential for implantable devices to advance study of dialysis physiology, review the ethical implications of using implantable devices in clinical studies, and report on the protocol and baseline results of the Monitoring in Dialysis Study (MiD).Design, setting, participants, & measurements In this multicenter, interventional-observational, prospective cohort study, we placed implantable loop recorders in patients undergoing long-term hemodialysis. The proportion of patients experiencing clinically significant arrhythmias was the primary endpoint. For 6 months, we captured detailed data on the primary endpoint, symptomatic arrhythmias, other electrocardiographic variables, dialysis prescription, electrolytes, dialysis-related variables, and vital signs. We collected additional electrocardiographic data for up to 1 year.Results Overall, 66 patients underwent implantation in sites in the United States and India. Diabetes was present in 63.6% of patients, 12.1% were age $70 years, 69.7% were men, and 53.0% were black. Primary and secondary endpoint data are expected in 2016.Conclusions Cardiac arrhythmia is an important contributor to cardiovascular morbidity and mortality in dialysis patients, but available technology has previously limited the ability to estimate its true burden and triggers and to define terminal rhythms in sudden death. Use of implantable technology in observational studies raises complex issues but may greatly expand understanding of dialysis physiology. The use of implantable loop recorders in MiD is among the first examples of such a trial, and the results are expected to provide novel insights into the nature of arrhythmia in hemodialysis patients.

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Section: Dialysis As a Triggermentioning

confidence: 94%

Arrhythmia and Sudden Death in Hemodialysis Patients

Charytan

Foley

McCullough

et al. 2016

Clinical Journal of the American Society of Nephrology

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“…Similar risk factors have also been suggested for the development of atrial fibrillation in HD patients (3,4). However, there are still conflicting data about the effect of HD, and various dialysis composition and dialysis protocols on the occurrence of atrial arrhythmias in HD patients (6)(7)(8).…”

mentioning

confidence: 68%

“…In HD patients, many of the reports on SAECG parameters are focused exclusively on ventricular SAECG (12)(13)(14). To the best of our knowledge, P-SAECG has been investigated only in a study of Jaroszynski et al (6), and it needs to be elucidated further.…”

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confidence: 99%

The Influence of Hemodialysis on P‐Wave Signal‐Averaged Electrocardiogram Findings

et al. 2007

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The role of P-wave signal-averaged electrocardiography (P-SAECG) in the prediction of atrial fibrillation (AF) attacks has been validated in various disease states. In the present study, we aimed to investigate the effect of hemodialysis (HD) on P-SAECG parameters and to determine the related risk factors that might affect those parameters. Ninety-one HD patients and 68 controls were included. Hemoglobin levels, serum electrolytes, arterial pH, and interdialytic weight changes were assessed. P-wave duration (PWD) and late potentials of P wave (root-mean-square voltage for the last 20 ms of the signal-averaged P wave [LP20]) were determined by P-SAECG. Pre- and postdialysis PWDs were significantly increased in HD patients than in controls (both P < 0.05), while the voltages of pre- and postdialysis LP20 were significantly reduced (both P < 0.05). A significant increase in PWD (P < 0.05) and a significant decrease in LP20 (P < 0.05) were observed following HD. Pre- and postdialysis PWDs and LP20 were correlated with age (all P < 0.05), dialysis duration (all P < 0.05), and left atrial diameters (LADs) (pre- and postdialysis) (all P < 0.05). Intradialytic changes in serum potassium levels were only correlated with postdialysis PWD and LP20 in HD patients (both P < 0.05). HD seems to increase PWD and to reduce LP20. Advanced age, duration of HD, intradialytic change in serum potassium levels, and LAD seem to be the important associates of P-SAECG parameters in HD patients.

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“…We did not find any significant change in P max durations throughout the HD session. Similarly, Jaroszyński et al [14] reported that HD process induced a significant decrease in the filtered P wave duration. However, Szabo et al [8] and Tezcan et al [9] reported that maximum P wave durations increased after dialysis compared with measurements before dialysis, resulting in an increase in PWD.…”

Section: Discussionmentioning

confidence: 89%

P Wave Dispersion Increases during Hemodialysis Sessions

Özben¹,

Toprak²,

Koç³

et al. 2009

Nephron Clin Pract

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Background/Aims: Atrial fibrillation (AF) is common among hemodialysis (HD) patients and is associated with high mortality. P wave dispersion (PWD) is a noninvasive electrocardiographic marker of paroxysmal AF. Our aim was to evaluate the effect of HD session on PWD. Methods: Twenty-five patients (mean age 63 years, 10 males) with sinus rhythm and undergoing chronic HD treatment were included. Blood samples were drawn and 12-lead electrocardiograms were recorded immediately before HD session, at the 2nd hour during HD and at the end of the HD session. The difference between maximum and minimum P wave durations was calculated as PWD. Results: PWD significantly increased during HD sessions compared with predialysis values (41 ± 12 vs. 21 ± 10 ms, respectively, p < 0.001), then decreased to a value of 24 ± 7 ms at the completion of HD, which was not significantly different from the predialysis values. PWD during HD was significantly correlated with predialysis systolic and diastolic blood pressure (r = 0.42, p = 0.037, and r = 0.59, p = 0.002, respectively) and predialysis serum potassium level (r = 0.44, p = 0.031). Linear regression model revealed that predialysis diastolic blood pressure (p = 0.002), predialysis serum potassium level (p = 0.037) and the amount of ultrafiltration (p = 0.048) were the significant predictors of prolonged PWD during HD. Conclusion: PWD increases significantly during HD sessions. This may increase the risk of AF episodes during HD. High diastolic blood pressure and serum potassium level before HD and ultrafiltration amount may predict prolonged PWD during HD.

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Effect of haemodialysis on signal-averaged electrocardiogram P-wave parameters

Cited by 12 publications

References 19 publications

Arrhythmia and Sudden Death in Hemodialysis Patients

Arrhythmia and Sudden Death in Hemodialysis Patients

The Influence of Hemodialysis on P‐Wave Signal‐Averaged Electrocardiogram Findings

P Wave Dispersion Increases during Hemodialysis Sessions

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