Cardiac Rhythm Disturbances in Hemodialysis Patients: Early Detection Using an Implantable Loop Recorder and Correlation With Biological and Dialysis Parameters.

Autor:	Sacher F; IHU LIRYC - Universite de Bordeaux, INSERM 1045, Bordeaux, France; Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France. Electronic address: frederic.sacher@chu-bordeaux.fr., Jesel L; Hôpitaux Universitaires de Strasbourg and Medical School of Strasbourg, Strasbourg, France., Borni-Duval C; Hôpitaux Universitaires de Strasbourg and Medical School of Strasbourg, Strasbourg, France., De Precigout V; Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France., Lavainne F; Centre Hospitalier Universitaire de Nantes, Nantes, France., Bourdenx JP; Clinique Saint-Augustin, Bordeaux, France., Haddj-Elmrabet A; Centre Hospitalier Universitaire de Rennes, Rennes, France., Seigneuric B; Centre Hospitalier Universitaire de Toulouse, Toulouse, France., Keller A; Centre Hospitalier de Libourne, Libourne, France., Ott J; Centre Hospitalier de Haguenau, Haguenau, France., Savel H; Unité de Soutien Méthodologique à la Recherche Clinique, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France., Delmas Y; Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France., Bazin-Kara D; Hôpitaux Universitaires de Strasbourg and Medical School of Strasbourg, Strasbourg, France., Klotz N; IHU LIRYC - Universite de Bordeaux, INSERM 1045, Bordeaux, France; Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France., Ploux S; IHU LIRYC - Universite de Bordeaux, INSERM 1045, Bordeaux, France; Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France., Buffler S; Centre Hospitalier de Haguenau, Haguenau, France., Ritter P; IHU LIRYC - Universite de Bordeaux, INSERM 1045, Bordeaux, France; Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France., Rondeau V; Unité de Soutien Méthodologique à la Recherche Clinique, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France., Bordachar P; IHU LIRYC - Universite de Bordeaux, INSERM 1045, Bordeaux, France; Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France., Martin C; IHU LIRYC - Universite de Bordeaux, INSERM 1045, Bordeaux, France; Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France., Deplagne A; Centre Hospitalier de Libourne, Libourne, France., Reuter S; Clinique Saint-Augustin, Bordeaux, France., Haissaguerre M; IHU LIRYC - Universite de Bordeaux, INSERM 1045, Bordeaux, France; Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France., Gourraud JB; Centre Hospitalier Universitaire de Nantes, Nantes, France., Vigneau C; Centre Hospitalier Universitaire de Rennes, Rennes, France., Mabo P; Centre Hospitalier Universitaire de Rennes, Rennes, France., Maury P; Centre Hospitalier Universitaire de Toulouse, Toulouse, France., Hannedouche T; Hôpitaux Universitaires de Strasbourg and Medical School of Strasbourg, Strasbourg, France., Benard A; Unité de Soutien Méthodologique à la Recherche Clinique, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France., Combe C; Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Unité INSERM 1026, Universite de Bordeaux, Bordeaux, France.
Jazyk:	angličtina
Zdroj:	JACC. Clinical electrophysiology [JACC Clin Electrophysiol] 2018 Mar; Vol. 4 (3), pp. 397-408. Date of Electronic Publication: 2017 Sep 27.
DOI:	10.1016/j.jacep.2017.08.002
Abstrakt:	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). (Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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