Abstract 10581: Cardio Renal Arrhythmia Study in Hemodialysis Patients Using Implantable Loop Recorders (CRASH-ILR)
Cardiac mortality in hemodialysis (HD) patients accounts for 43% of deaths, 58% of these are attributed to arrhythmias. Explanations for an arrhythmic cause in this population include left ventricular hypertrophy, coronary artery disease, electrolyte imbalance, volume changes, myocardial fibrosis/hypertrophy. Palpitations/syncope are frequently reported by this population. The true incidence of arrhythmic burden in the HD population has never been comprehensively studied. We report the interim analysis of the prospective use of an ILR in this population.
Methods: 18 pts (15 male, EF 55±8%) aged 68±8 yrs consented to implantation of an ILR (Reveal XT, Medtronic, USA). Pts had been on HD for 33±22 months prior to recruitment with a variety of aetiologies of CKD including diabetes, hypertension, amyloid, glomerulonephritis. Device programming was standardized to include automatic detection of brady/tachy arrhythmias and patient activated recordings (PAR). After ILR implantation pts were encouraged to remotely transmit at each dialysis session. All transmissions were reviewed and events analysed by an events committee.
Results: To date there have been 124,512 hours continuous monitoring (6917±4281). 1059 transmissions (62±48) have been made and 11 PARs. There have been significant clinical events in 4 pts: ILR demonstrated >3 sec pauses requiring pacemaker implantation, one died from SCD and ILR interrogation identified ventricular fibrillation, one required ILR explantation due to infection and died from unrelated SCD several weeks later, one had sudden onset of atrial tachycardia requiring anti arrhythmic drugs. All PARs corresponded to sinus rhythm. Automatic detection identified 756 bradycardic events (99.6% due to device undersensing) and 5520 tachycardic events (99.9% due to oversensing).
Conclusions: Clinical research involving multiple specialities is challenging but this study has successfully bridged the cardiorenal interface. In >5000 days of continuous ECG recording in pts on HD >22% had significant events. PARs were not associated with arrhythmias. This study aims to document >30,000 days of monitoring and so will offer a significant insight into the event rate and true nature of the arrhythmic burden of HD.
- © 2013 by American Heart Association, Inc.