Factors influencing P terminal force in lead V1 of the ECG in hemodialysis patients

Abstract

IntroductionAtrial fibrillation (AF) is a highly prevalent arrhythmia in hemodialysis (HD) patients, and an HD session may be a trigger for AF episodes. An abnormal P-terminal force in lead V1 (PTFV1) may predict new-onset AF in HD patients. The aim of the study was to assess the influence of the HD process on PTFV1 and to evaluate possible factors influencing PTFV1 in a group of selected HD patients.Material and methodsOne hundred and fifty-three selected HD patients entered the study. Blood chemistry, electrocardiography, and impedance cardiography were evaluated before and after HD. Echocardiography was performed on the morning after dialysis. Abnormal PTFV1 was defined as PTFV1 > 40 mm × ms.ResultsAbnormal PTFV1 was found in 35.3% of patients before dialysis and in 48.4% of patients after dialysis. The results of multiple regression analysis revealed that the independent predictors of pre-dialysis abnormal PTFV1 were: left atrial volume index (p = 0.002), left ventricular mass index (p = 0.014), and pre-dialysis thoracic fluid content (p = 0.021) values. The independent predictors of HD-induced abnormal PTFV1 values were larger differences between pre-dialysis and post-dialysis values of serum potassium (p < 0.001) and mean arterial pressure (p = 0.008).ConclusionsAbnormal PTFV1 is prevalent in HD patients. The HD process adversely affects PTFV1 values. Pre-dialysis abnormal PTFV1 is mainly associated with structural heart abnormalities and hydration status. HD-induced abnormal PTFV1 is associated predominantly with serum potassium changes as well as HD-induced hypotension. Our results suggest possible risk factors for AF; however, their clinical significance needs to be confirmed in follow-up studies.

Interatrial block, P terminal force or fragmented QRS do not predict new-onset atrial fibrillation in patients with severe chronic kidney disease

“…both patterns was comparable to previous studies in hemodialysis patients [11,12]. However, we found no connection between LAE and new-onset AF.…”

“…The prevalence of IAB and PTF was high in our patients with severe CKD not on dialysis and the rate of both patterns was comparable to previous studies in hemodialysis patients [ 11 , 12 ]. However, we found no connection between LAE and new-onset AF.…”

“…In fact, both IAB and PTF have been associated with hypertension, CAD and heart failure which were highly prevalent conditions in our study cohort [ 13 – 15 ]. Both IAB and PTF have been described to reflect the presence of LAE and to predict the incidence of new-onset AF in various populations [ 6 , 12 , 16 – 18 ] but not in CKD patients.…”

The influence of cognitive-behavioral therapy on depression in dialysis patients – meta-analysis

“…The pharmacological treatment of depression in this group of patients is particularly difficult because of the increased risk of side effects due to impaired renal function and high drug load. The most common comorbidities in this group of patients are hypertension, diabetes, atrial fibrillation, coronary heart disease and infections [40,41]; therefore, the inclusion of a new antidepressant may adversely affect the effectiveness of the entire treatment regimen. It should be emphasized that the lack of knowledge on the safe use of antidepressants among patients on dialysis is partly due to the frequent exclusion of this group of patients from clinical trials [42].…”

“…In the opinion of Cukor et al, such an intervention, focused on working with non-adaptive patterns of thinking and feelings, may become a safe and effective alternative to pharmacotherapy, which itself may be associated with higher risk in the absence of efficacy. Relationships between depression and compliance with medical recommendations, frequency of hospitalization, mortality, and quality of life, suggest that appropriate treatment of depressive disorders may play an important role in the overall treatment effect of patients with renal disorders [41].…”