What is the clinical evidence from this study?

Study design: Cohort. Population: End-stage renal disease on hemodialysis awaiting renal transplant (n=100). Intervention: Long QTc interval vs. Normal QTc interval. Primary outcome: Bradyarrhythmias detected by implantable loop recorder (OR 7.28, 95% CI 2.01-26.35, p=0.002).

January 1, 2015Arquivos Brasileiros de CardiologiaOpen Access

Predictors of Arrhythmic Events Detected by Implantable Loop Recorders in Renal Transplant Candidates

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Key result

In renal transplant candidates on hemodialysis, continuous monitoring with an implantable loop recorder detected arrhythmic events in 98% of patients, with a long QTc interval independently predicting bradyarrhythmias (OR 7.28).

Population

100 ambulatory renal transplant candidates on chronic hemodialysis with a high cardiologic risk profile…

Design

Cohort

Follow-up

mean 424 ± 127 days

Authors

RSRodrigo Tavares SilvaUniversidade de Franca MFMartino Martinelli FilhoElectrophysiology GPGiselle de Lima PeixotoInserm

Discussion

Member takes

Implication

Alerts clinicians to arrhythmic risk in hemodialysis transplant candidates; leaves open whether routine ILR monitoring improves outcomes.

Study Design

Type

Cohort (n=100)

Multicenter

Structured PICO

Population

100 consecutive ambulatory renal transplant candidates on chronic hemodialysis with a high cardiologic risk profile, monitored with an implantable loop recorder for a mean of 424 days.

Exposure

Implantable loop recorder (Reveal XT 9529) for continuous ECG monitoring for at least 1 year.

Outcome

Incidence and predictors of arrhythmic events (AE) detected by implantable loop recorder during follow-up.

Main Result

Odds Ratio: 7.28 (95% CI 2.01–26.35)

p-value: p=0.002

Continuous monitoring with an implantable loop recorder in high-risk hemodialysis patients reveals a 98% incidence of arrhythmic events, with prolonged QTc and PR intervals predicting bradyarrhythmias and left ventricular dilatation predicting non-sustained ventricular tachycardia.

Limitations

Single-center study from an academic institute, which may limit generalizability to other renal transplant candidates.
Implantable loop recorder uses a single subcutaneous ECG lead, making atrial depolarization difficult to identify.
The device algorithm requires 2 minutes to identify atrial fibrillation, missing shorter episodes.
Device memory is limited to 30 arrhythmic event recordings, which can lead to loop memory overwriting and underestimation of true incidence in patients with frequent arrhythmias.
Single academic center cohort limits generalizability
ILR limitations including single subcutaneous ECG lead making atrial depolarization difficult to identify
2-minute observation requirement for AF algorithm
Limited memory capacity of 30 AE recordings potentially underestimating true incidence

Cite This Study

Silva et al. (2015) conducted a cohort in End-stage renal disease on hemodialysis awaiting renal transplant (n=100). Long QTc interval vs. Normal QTc interval was evaluated on Bradyarrhythmias detected by implantable loop recorder (OR 7.28, 95% CI 2.01-26.35, p=0.002). In renal transplant candidates on hemodialysis, continuous monitoring with an implantable loop recorder detected arrhythmic events in 98% of patients, with a long QTc interval independently predicting bradyarrhythmias (OR 7.28).

synapsesocial.com/papers/6a982e4c3de45e4adad7e0da https://doi.org/10.5935/abc.20150106

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Predictors of Arrhythmic Events Detected by Implantable Loop Recorders in Renal Transplant Candidates

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Predictors of Arrhythmic Events Detected by Implantable Loop Recorders in Renal Transplant Candidates

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Also Consider