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 10-3events/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.
Key words: Ventricular arrhythmia, CIED, end-stage renal disease,
hemodialysis