Abstract 19584: Frequency and Distribution of Hemodialysis (HD)-Associated Atrial Fibrillation: Preliminary Results of the (MiD) Study
Introduction: ESRD patients are at increased risk for atrial arrhythmias. Atrial fibrillation (AF) prevalence up to 40% has been reported in HD patients, but the relationship of AF onset to the HD cycle is unknown.
Methods: MiD is a prospective multi-center study to characterize arrhythmias in 3x weekly HD patients with an implantable continuous cardiac monitoring device, the Medtronic Reveal® XT. HD treatment data are collected concurrently during the initial 6 months. The Reveal XT detects AF episodes based on incoherence in adjacent R-R intervals. Previous validation of Reveal XT AF detection against Holter monitoring showed 92% sensitivity and 80% positive predictive value for AF episodes ≥6 minutes (min) in duration.
Results: Follow-up is available for 45 subjects [mean follow-up 4.9mo (0.6-6.0mo), mean age 56 (27-76yrs), 36% female]. 1253 AF episodes ≥6 min long were detected in 18 of 45 (40.0%) subjects, occurring at a rate of 5.6 (95%CI=2.1-15.4) events per patient month (ppm). In the 18 subjects with any episodes, the rate of AF events ≥6 min was 14.1 (95%CI=6.3-31.7) ppm. The risk of AF onset peaks in the 12 hours after the start of the first HD session of the week following the long interdialytic interval. Total duration of AF episodes ≥6 min in these 18 subjects was 1866 hours. Only 5 of the total 45 subjects (11%) had any prior history of AF. Seventy two percent of the patients having any episodes of AF (13/18) were not on warfarin at study entry while 39% (7/18) had a prior diagnosis of congestive heart failure, and 61% (11/18) had a prior history of coronary artery disease. Twelve of 13 subjects not on warfarin had CHADS2 scores ≥2.
Conclusions: AF is common and often undiagnosed in ESRD with 40% of MiD patients having at least one sustained episode (≥6 min) and only 11% of these patients having any prior history. The dialysis procedure may directly increase AF risk with the greatest risk of AF onset occurring during the first 12 hours after HD initiation. Since 66% of our subjects had an indication for anticoagulation, early detection of AF is crucial.
Author Disclosures: A.I. Costea: Speakers Bureau; Modest; Biotronik.
- © 2014 by American Heart Association, Inc.