Abstract
Sudden Cardiac Death (SCD) is the leading cause of cardiovascular death in dialysis patients. This review discusses potential underlying arrhythmic mechanisms of SCD in the dialysis population. It examines recent evidence from studies using implantable loop recorders and from electrophysiological studies in experimental animal models of chronic kidney disease. The review summarizes advances in the field of non-invasive electrophysiology for risk prediction in dialysis patients focusing on the predictive value of the QRS-T angle and of the assessments of autonomic imbalance by means of heart rate variability analysis. Future research directions in non-invasive electrophysiology are identified to advance the understanding of the arrhythmic mechanisms. A suggestion is made of incorporation of non-invasive electrophysiology procedures into clinical practice.Key Concepts:– Large prospective studies in dialysis patients with continuous ECG monitoring are required to clarify the underlying arrhythmic mechanisms of SCD in dialysis patients.– Obstructive sleep apnoea may be associated with brady-arrhythmias in dialysis patients. Studies are needed to elucidate the burden and impact of sleeping disorders on arrhythmic complications in dialysis patients.– The QRS-T angle has the potential to be used as a descriptor of uremic cardiomyopathy.– The QRS-T angle can be calculated from routine collected surface ECGs. Multicenter collaboration is required to establish best methodological approach and normal values.– Heart Rate Variability provides indirect assessment of cardiac modulation that may be relevant for cardiac risk prediction in dialysis patients. Short-term recordings with autonomic provocations are likely to overcome the limitations of out of hospital 24-h recordings and should be prospectively assessed.
Highlights
Chronic kidney disease affects 5–7% of the global population and is associated with a 10-fold increase in cardiovascular mortality
This review summarizes the recent evidence from the use of implantable loop recorder (ILR) in HD patients and electrophysiological studies in animal models of chronic kidney disease (CKD), exploring the potential underlying arrhythmic mechanisms
This study reported that T wave residuum, a descriptor of regional repolarization heterogeneity (Zabel and Malik, 2002), was an independent predictor of cardiovascular mortality and sudden cardiac death (SCD)
Summary
Chronic kidney disease affects 5–7% of the global population and is associated with a 10-fold increase in cardiovascular mortality. SCD accounts for a large proportion of cardiovascular deaths and almost one fourth of the overall mortality in these patients as evidenced from registry data (United States Renal Data System, 2012) and from prospective trials with death adjudication (Cheung et al, 2004; Wanner et al, 2005). High risk of SCD is present even at early stages of CKD but it increases substantially when patients are on HD. This high risk is aggravated by the fluctuations in volume and electrolyte status induced by the intermittent pattern of the treatment (Poulikakos et al, 2014a)
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
