Implantable Loop Recorder Monitoring and the Incidence of Previously Unrecognized Atrial Fibrillation in Patients on Hemodialysis

Abstract

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Wearables in Nephrology: Fanciful Gadgetry or Prêt-à-Porter?

“…Arrhythmias are common in patients with ESKD and related to outcome. Data from implantable loop recorders showed a high prevalence of atrial fibrillation (AF) but also stressed the importance of bradyarrhythmias as potential harbingers of sudden cardiac death in this population [ 13 , 14 ]. To the best of our knowledge, there are no published studies on arrhythmia detection using non-invasive, wearable devices specifically in this population.…”

Atrial Fibrillation in Kidney Failure: Challenges in Risk Assessment and Anticoagulation Management

“…The Monitoring in Dialysis study 23 supported these findings and further reported a median of 7 days with AF but ranging from 1-161 days. 24 Subclinical AF has not been characterized in peritoneal dialysis cohorts, although there is no difference in AF incidence between hemodialysis and peritoneal dialysis cohorts beyond 90 days after dialysis commencement. 25 In a population where CHA 2 DS 2 -VASc scores are high, the interaction between clinical risk factors and AF type or burden may inform stroke risk.…”

“…Some episodes will self-terminate, but subclinical AF may go unrecognized for extended periods of time. 24 The prognostic significance of these episodes is unclear, and there is likely to be significant clinician variability in OAC practice in this population.…”

“…A study of 40 patients treated by kidney replacement therapy who received a dual-chamber implantable cardioverter defibrillator in the Implantable Cardioverter-Defibrillator in Dialysis Patients (ICD-2) trial demonstrated an association between volume removal and dialysate potassium concentration, 28 although this was not replicated in the Monitoring in Dialysis study using implantable cardiac monitors. 24 This also raises the potential for stroke risk to be dynamic according to volume status, electrolyte changes, and dialysis prescription. The concept of cardioprotective hemodialysis to minimize cardiovascular harm is not new, but attention to dialysis prescription to modulate AF burden and stroke risk warrants consideration.…”