Abstract 14194: Is the High Prevalence of Atrial Fibrillation in End Stage Renal Disease Related to the Hemodialysis Procedure Itself?
Background. Atrial fibrillation (AF) is common in patients with end stage renal disease (ESRD) and is associated with an increased risk of complications such as stroke. Pathophysiology might be related to common risk factors of both AF and ESRD or to dialysis-specific factors. Information on the exact onset of AF in relation to the hemodialysis (HD) procedure could provide valuable insights regarding the pathophysiology of AF. The purpose of this study was to determine the onset of AF in relation to the HD procedure itself, in a dialysis population.
Methods. All dialysis patients currently enrolled in the ICD2 trial (ISRCTN20479861) in which an ICD was implanted were included. All days recorded by the home-monitoring were analyzed for the onset of AF. The relationship between AF and the HD procedure was subsequently assessed. All HD procedures during which AF developed were further analyzed and compared to HD procedures in which AF did not develop.
Results. A total of 41 patients were included (follow-up 27±16 months, 81% male, 70±8 years). From this group, 14 patients developed a total of 428 episodes of AF during follow-up. The onset of paroxysmal AF was seen significantly more on the days of the HD procedure (graph, p<0,001 ) with the highest percentage of episodes starting around the last hour(s) of the procedure. HD procedures in which AF developed were associated with a significantly higher dialysis volume (p<0,008) and a lower potassium concentration in the dialysis fluid (p<0,001), compared to procedures in which AF did not develop.
Conclusion. This is the first study to show a clear relationship between the onset of AF and the dialysis procedure itself. Volume shifts are larger in the HD procedures in which AF start and the time of onset clusters around the last hours of the HD procedure. These findings point to a possible important role for intravascular volume depletion and potassium flux in the pathophysiology of AF.
- © 2012 by American Heart Association, Inc.