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Ventricular Arrhythmia Burden and Relationship to Interdialytic Period in Dialysis Patients with Cardiac Devices
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  • Evan Harmon,
  • Brittney Heard,
  • Sarah Ratcliffe,
  • Mark Smolkin,
  • J Michael Mangrum,
  • Sula Mazimba,
  • Brendan Bowman,
  • Nishaki Mehta
Evan Harmon
University of Virginia Health System
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Brittney Heard
University of Virginia Health System
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Sarah Ratcliffe
University of Virginia Health System
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Mark Smolkin
University of Virginia Health System
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J Michael Mangrum
University of Virginia Health System
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Sula Mazimba
University of Virginia Health System
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Brendan Bowman
University of Virginia Health System
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Nishaki Mehta
William Beaumont Hospital - Royal Oak
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Abstract

Background: Sudden cardiac death (SCD) is a major driver of mortality in patients with end-stage renal disease (ESRD) on hemodialysis (HD). The degree to which ventricular arrhythmias (VA) play a role in SCD in ESRD patients is unclear. Objective: Use cardiac implantable electronic devices (CIEDs) to clarify VA burden in ESRD patients overall and in relation to interdialytic cycle. Methods: We identified 44 patients at a single academic center with CIEDs, 22 on HD, along with 22 age- and sex-matched controls. Device interrogations from 11/13/14 – 4/8/19 were reviewed. Results: Overall, there were no differences in HD patients and controls in adjusted overall event rate (HD 9.81 x 10-5 ± 1.5 x 10-3 events/patient-hours vs control 3.71 x 10-5 ± 9.1 x 10-4 events/patient-hours, p = 0.902), or proportion of patients experiencing VA event (HD 45.4% vs control 63.6%, p = 0.226). There was no difference in ventricular pacing burden. Controls were more likely to require device therapy for VT/VF episodes (total ATP episodes 2/38 in HD vs 10/22 in controls, p < 0.01, total ICD shocks 10/38 in HD vs 17/22 in controls, p < 0.01). HD patients were most likely to experience VA within 12-hours of HD completion (p < 0.01), and the vast majority of events were NSVT. Conclusion: VA and ventricular pacing burden was similar by CIED analysis between groups. In HD patients, VA were likely to occur within the first 12 hours post-dialysis, were primarily NSVT, and were unlikely to require device therapy.