Severe coronary stenosis is an important factor for induction and lengthy persistence of ventricular arrhythmias during and after hemodialysis

Kitano, Yukari; Kasuga, Hirotake; Watanabe, M; Ibuki, Koichi; Kawade, Yasumasa; Yasuda, Kaoru; Iwashima, Shigejiro; Toriyama, Takanobu; Matuo, Seiichi; Kawahara, Hirohisa

doi:10.1053/j.ajkd.2004.04.037

Cited by 17 publications

(9 citation statements)

References 19 publications

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“…in patients undergoing hemodialysis, coronary artery disease probably causes arrhythmogenesis as severe coronary stenosis is associated with the induction and lengthy persistence of ventricular arrhythmias during and after hemodialysis. 23,24 Furthermore, the number of PvCs during and after hemodialysis is higher in patients with than in those without ischemic heart disease. 22 Figure 3 | The pathophysiology of diseases that predispose patients with chronic kidney disease to cardiac arrest.…”

Section: Epidemiologymentioning

confidence: 99%

Sudden cardiac death in chronic kidney disease: epidemiology and prevention

2011

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Annual cardiovascular mortality in patients with chronic kidney disease (CKD) is much higher than in the general population. The rate of sudden cardiac death increases as the stage of CKD increases and could be responsible for 60% of cardiac deaths in patients undergoing dialysis. In hemodialysis units treating patients with CKD, cardiac arrest occurs at a rate of seven arrests per 100,000 hemodialysis sessions. Important risk factors for sudden cardiac death in patients with CKD include hospitalization within the past 30 days, a drop of 30 mmHg in systolic blood pressure during hemodialysis, duration of life on hemodialysis, time since the previous dialysis session, and the presence of concomitant diabetes mellitus. As a result of the adverse cardiomyopathic and vasculopathic milieu in CKD, the occurrence of arrhythmias, conduction abnormalities, and sudden cardiac death could be exacerbated by electrolyte shifts, divalent ion abnormalities, diabetes, sympathetic overactivity, in addition to inflammation and perhaps iron deposition. Impaired baroreflex effectiveness and sensitivity, as well as obstructive sleep apnea, might also contribute to the risk of sudden death in CKD. The likelihood of survival following cardiac arrest is very low in dialysis patients. Primary and secondary prevention of cardiac arrest could reduce cardiovascular mortality in patients with CKD. Cardioverter-defibrillator implantation decreases the risk of sudden death in patients with CKD. The decision to implant a cardioverter-defibrillator should be influenced by the patient's age and stage of CKD.

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Section: Epidemiologymentioning

confidence: 99%

Sudden cardiac death in chronic kidney disease: epidemiology and prevention

2011

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“…The frequency and prevalence of intra-and post-dialytic ventricular arrhythmias are higher in patients with significant coronary stenoses, [12] suggesting that myocardial ischemia plays a direct role in the induction and persistence of ventricular arrhythmias during and after HD. Myocardial ischemia is also known to lead to the development of regional wall motion abnormalities (RWMAs) and myocardial stunning as a direct consequence of HD.…”

Section: Introductionmentioning

confidence: 99%

Hemodialysis-Induced Left Ventricular Dysfunction Is Associated with an Increase in Ventricular Arrhythmias

et al. 2008

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Conventional hemodialysis results in intradialytic cardiac ischemia in a significant proportion of patients. Segmental myocardial ischemia results in the development of left ventricular regional wall motion abnormalities. Sudden death is the most common cause of mortality in hemodialysis patients. This study looked to examine any association between the development of left ventricular regional wall motion and cardiac arrhythmias. Forty established hemodialysis patients had 24-hour Holter recordings, which commenced immediately before a dialysis session. Frequency of isolated ectopy was classified as a percentage of the total beats on the Holter monitor record. Ventricular arrhythmias were stratified according to the Lown classification. Classes 3 and above were taken as complex ventricular arrhythmias. Patients also underwent baseline and intradialytic echocardiography to assess the development of concurrent regional wall motion abnormalities. Premature ventricular complexes and complex ventricular arrhythmias were both more common during hemodialysis than in the subsequent monitored period. Patients who developed regional wall motion abnormalities (n = 27) had significantly more premature ventricular complexes during hemodialysis than afterward ( p < 0.001). Patients with ischemic heart disease and left ventricular hypertrophy both had a higher frequency of premature ventricular complexes during hemodialysis than those without ( p < 0.03 and p < 0.02, respectively).Cardiac arrhythmias are common in hemodialysis patients. The frequency of premature ventricular complexes is significantly higher during hemodialysis in patients who develop regional wall motion abnormalities and may be related to factors associated with demand ischemia.

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“…In one cohort, 64% of haemodialysis patients who suffered SCD had CAD . Haemodialysis patients with ≥75% coronary stenosis have a higher frequency of induction and persistence of Lown Class 4 ventricular arrhythmia during and after dialysis compared with those without coronary stenosis …”

Section: Pharmacological Therapiesmentioning

confidence: 99%

Sudden cardiac death in haemodialysis patients: Preventative options

et al. 2014

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ABSTRACT:Sudden cardiac death (SCD) is the most common cause of death in haemodialysis patients, accounting for 25% of all-cause mortality. There are many potential pathological precipitants as most patients with end-stage renal disease have structurally or functionally abnormal hearts. For example, at initiation of dialysis, 74% of patients have left ventricular hypertrophy. The pathophysiological and metabolic milieu of patients with end-stage renal disease, allied to the regular stresses of dialysis, may provide the trigger to a fatal cardiac event. Prevention of SCD can be seen as a legitimate target to improve survival in this patient group. In the general population, this is most effective by reducing the burden of ischaemic heart disease. However, the aetiology of SCD in haemodialysis patients appears to be different, with myocardial fibrosis, vascular calcification and autonomic dysfunction implicated as possible causes. Thus, the range of therapies is different to the general population. There are potential preventative measures emerging as our understanding of the underlying mechanisms progresses. This article aims to review the evidence for therapies to prevent SCD effective in the general population when applied to dialysis patients, as well as promising new treatments specific to this population group.

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Severe coronary stenosis is an important factor for induction and lengthy persistence of ventricular arrhythmias during and after hemodialysis

Cited by 17 publications

References 19 publications

Sudden cardiac death in chronic kidney disease: epidemiology and prevention

Sudden cardiac death in chronic kidney disease: epidemiology and prevention

Hemodialysis-Induced Left Ventricular Dysfunction Is Associated with an Increase in Ventricular Arrhythmias

Sudden cardiac death in haemodialysis patients: Preventative options

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