Key result
Hemodialysis significantly prolonged P-wave duration (from 135.5 to 144.6 ms) and reduced RMS20 (from 5.51 to 3.05 μV), indicating increased vulnerability to atrial arrhythmias during the procedure.
Why the study?
Does hemodialysis induce alterations in P-wave signal-averaged electrocardiogram parameters indicative of vulnerability to atrial arrhythmias in patients with end-stage kidney disease?
Observational (n=33)
Yes
Does hemodialysis induce alterations in P-wave signal-averaged electrocardiogram parameters indicative of vulnerability to atrial arrhythmias in patients with end-stage kidney disease?
Absolute Event Rate: 144.6% vs 135.5%
p-value: p=<0.05
Hemodialysis induces transient prolongation of P-wave duration and reduction of RMS20, suggesting increased vulnerability to atrial arrhythmias during the procedure.
HD may transiently heighten AF vulnerability in ESKD; leaves open whether P-SAECG changes warrant arrhythmia monitoring.
BACKGROUND: Atrial fibrillation (AF) is the most common supraventricular arrhythmia, often occurring during hemodialysis (HD). Prolongation of the total filtered P-wave duration (PWD) and reduction of the root mean square voltages for the last 20 ms of the P wave (RMS20) on a P-wave signal-averaged electrocardiogram (P-SAECG) are predictors of AF. We investigated whether HD induces alterations of P-SAECG, and determined the influential factors. METHODS AND RESULTS: Thirty-three end-stage kidney disease patients (66.7 ± 12.6 years, 23 males) undergoing maintenance HD were enrolled in this study. Digital ambulatory P-SAECG monitoring and laboratory examination of serum proteins and ions were carried out before, during, and after the HD sessions. Data were analyzed by multiple regression analysis. PWD was significantly prolonged, and RMS20 significantly reduced, during HD. These values recovered after completion of HD. Multiple regression analysis showed that prolongation of PWD significantly correlated with HD duration and the rate of removal of body fluid. On the other hand, RMS20 significantly correlated with HD duration and blood urea nitrogen variation. CONCLUSIONS: HD resulted in prolongation of PWD and reduction of RMS20, indicating the vulnerability of HD patients to AF. These P-SAECG changes correlated with HD duration and the rate of removal of the body fluid. These findings underline the importance of the control of dialysis variables in the prevention of atrial arrhythmias following HD.
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Shimada et al. (2012) conducted an observational in End-stage kidney disease (n=33). Hemodialysis vs. Before hemodialysis (baseline) was evaluated on P-wave duration (PWD) and root mean square voltages for the last 20 ms of the P wave (RMS20) (p=<0.05). Hemodialysis significantly prolonged P-wave duration (from 135.5 to 144.6 ms) and reduced RMS20 (from 5.51 to 3.05 μV), indicating increased vulnerability to atrial arrhythmias during the procedure.
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