Abstract
Abnormal signal-averaged ECG (SAECG) with presence of late potential (LP) is predictive of ventricular arrhythmias and sudden cardiac death in patients with ischemic and non-ischemic cardiomyopathy. Studies have shown that cardiovascular mortality and sudden cardiac death is higher in patients with chronic kidney disease (CKD) compared to the general population. The aim of this study is to evaluate the prevalence of LP and its association with CKD amongst individuals of similar age and co-morbidities. We recruited 155 CKD patients (106 hemodialysis, and 49 CKD patients with a mean eGFR40.08±10.4), and 52 patients with normal kidney function. SAECG was performed on all patients at recruitment, and immediately prior to a hemodialysis session if receiving dialysis. LP in SAECG was present when at least two of the following criteria were met: filtered-QRS duration ≥114ms; low-amplitude-signal ≥38ms, root-mean-square of the terminal 40ms of QRS ≤20μV. Odds ratio (OR) and 95% CI was generated using binary logistic regression adjusting for plausible confounders. Significance determined when P <0.05. LP was detected in 31% of CKD patients and 29% of patients with normal kidney function. After adjusting for potential confounders, LP was not associated with CKD status (OR 0.58, 95% CI 0.25-1.34). However, older age (p=0.014), male sex (p=0.005) and previous coronary artery disease (p=0.035) were significant predictors of LP (Table 1). Although CKD has been associated with increased cardiac mortality (including arrhythmias and sudden cardiac death) and abnormal ECG parameters, the presence of LP in SAECG was not associated with CKD in this cohort. More traditional cardiac risk factors such as older age, male sex and coronary artery disease were associated with LP independent of CKD status. This observation would support a potentially differing pathogenesis for malignant arrhythmia between CKD patients and other populations at risk of sudden cardiac death.
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