What is the clinical evidence from this study?

Study design: Case Report. Population: End-stage kidney disease with new-onset atrial fibrillation (n=1). Intervention: Intravenous amiodarone. Primary outcome: Rhythm and rate control.

April 10, 2026Open Access

First Documented Atrial Fibrillation Triggered by Dialysis-Induced Autonomic Instability in End-Stage Kidney Disease

Key Result

Intravenous amiodarone achieved partial rate control and intermittent reversion to sinus rhythm in a 59-year-old man with ESKD who developed atrial fibrillation immediately after hemodialysis.

Key Points

To document a case of atrial fibrillation triggered by dialysis-induced autonomic instability in a patient with end-stage kidney disease.
Case report of a 59-year-old man with end-stage kidney disease
Patient underwent thrice-weekly hemodialysis
Intravenous amiodarone was administered for rhythm control
Cautious crystalloid resuscitation was used
Patient developed his first documented atrial fibrillation immediately after dialysis
Maintained hemodynamic stability with amiodarone
Partial reversion to sinus rhythm achieved after treatment

Study Design

Type

Case Report (n=1)

Multicenter

Structured PICO

Population

59-year-old man (n=1) with end-stage kidney disease on thrice-weekly hemodialysis, coexisting hypotension, asthma, and severely reduced left ventricular ejection fraction, presenting with first documented atrial fibrillation with rapid ventricular response immediately after dialysis.

Intervention

Intravenöse Amiodaron und vorsichtige Kristalloiddrehung

Outcome

Rhythmus- und partielle Frequenzkontrolle, hämodynamische Stabilität und intermittierende Rückkehr zum Sinusrhythmus

Intravenous amiodarone serves as an effective individualized treatment for dialysis-induced atrial fibrillation with rapid ventricular response when standard rate-control therapies are contraindicated due to complex comorbidities like hypotension, asthma, and reduced LVEF.

Limitations

Detailed dialysis parameters, including dialysate composition and ultrafiltration volume, were not available
A definitive causal relationship cannot be established from a single observation
Long-term follow-up data were not available at the time of writing

Abstract

Atrial fibrillation (AF) is the most common sustained arrhythmia in the general population. However, it is seldom the initial rhythm disturbance in dialysis-dependent patients, who more often present with bradyarrhythmias or ventricular tachyarrhythmias. We report a 59-year-old man with end-stage kidney disease on thrice-weekly hemodialysis who developed his first documented AF with rapid ventricular response immediately after dialysis. Coexisting hypotension, asthma, and severely reduced left ventricular ejection fraction limited the use of β-blockers, calcium channel blockers, and digoxin. Given these limitations, intravenous amiodarone was selected as the most appropriate option, providing both rhythm and partial rate control while maintaining hemodynamic stability, and cautious crystalloid resuscitation was administered, resulting in partial stabilization and intermittent reversion to sinus rhythm. This case illustrates dialysis as a direct arrhythmogenic stressor through autonomic imbalance and electrolyte shifts, with underlying ventricular dysfunction serving as a substrate. It emphasizes the challenges of managing AF when standard therapies are contraindicated and highlights the importance of individualized treatment in dialysis patients with complex comorbidities.

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