INTRODUCTION
Sudden cardiac death (SCD) is the most common cause of death in patients
with end-stage renal disease (ESRD) on hemodialysis (HD) [1].
Two-thirds of these sudden deaths are due to fatal arrhythmias,
accounting for 26% of overall mortality [2-5]. Historically,
ventricular arrhythmias (VA) have been thought to be the primary driver
of SCD in this population. However, emerging data suggest that
bradyarrhythmias and asystole, rather than VA, may be the major cause of
arrhythmia-related death in ESRD patients [6-7]. Beyond arrhythmia
etiology itself, temporal relationships have been demonstrated between
arrhythmia burden, SCD, and HD schedule, such that the
long-interdialytic period (72-hours, LIDP) has been associated with
higher rates of arrhythmic events, as well as increased hospitalization
rates and mortality [6-11]. Thus, there is a crucial need for
clarification of both tachy- and bradyarrhythmia etiology, prevalence,
and contribution to mortality in ESRD patients on HD, while also
defining the temporal relationships between interdialytic period
duration and arrhythmia risk. Cardiac implantable electronic devices
(CIEDs) offer a unique and underutilized source of rhythm data analysis
which might be used to investigate the differences in arrhythmia risk
and timing between ESRD patients on HD and controls. To our knowledge,
this is the first study systematically evaluating the arrhythmia burden
in ESRD patients with CIEDs compared to control patients with CIEDs.