Hemodialysis Procedure–Associated Autonomic Imbalance and Cardiac Arrhythmias: Insights From Continuous 14‐Day ECG Monitoring
Background In patients with end‐stage kidney disease, sudden cardiac death is more frequent after a long interdialytic interval, within 6 hours after the end of a hemodialysis session. We hypothesized that the occurrence of paroxysmal arrhythmias is associated with changes in heart rate and heart ra...
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Wiley
2019-10-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.119.013748 |
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| author | Nichole M. Rogovoy Stacey J. Howell Tiffany L. Lee Christopher Hamilton Erick A. Perez‐Alday Muammar M. Kabir Yanwei Zhang Esther D. Kim Jessica Fitzpatrick Jose M. Monroy‐Trujillo Michelle M. Estrella Stephen M. Sozio Bernard G. Jaar Rulan S. Parekh Larisa G. Tereshchenko |
| author_facet | Nichole M. Rogovoy Stacey J. Howell Tiffany L. Lee Christopher Hamilton Erick A. Perez‐Alday Muammar M. Kabir Yanwei Zhang Esther D. Kim Jessica Fitzpatrick Jose M. Monroy‐Trujillo Michelle M. Estrella Stephen M. Sozio Bernard G. Jaar Rulan S. Parekh Larisa G. Tereshchenko |
| author_sort | Nichole M. Rogovoy |
| collection | DOAJ |
| description | Background In patients with end‐stage kidney disease, sudden cardiac death is more frequent after a long interdialytic interval, within 6 hours after the end of a hemodialysis session. We hypothesized that the occurrence of paroxysmal arrhythmias is associated with changes in heart rate and heart rate variability in different phases of hemodialysis. Methods and Results We conducted a prospective ancillary study of the Predictors of Arrhythmic and Cardiovascular Risk in End Stage Renal Disease cohort. Continuous ECG monitoring was performed using an ECG patch, and short‐term heart rate variability was measured for 3 minutes every hour (by root mean square of the successive normal‐to‐normal intervals, spectral analysis, Poincaré plot, and entropy), up to 300 hours. Out of enrolled participants (n=28; age 54±13 years; 57% men; 96% black; 33% with a history of cardiovascular disease; left ventricular ejection fraction 70±9%), arrhythmias were detected in 13 (46%). Nonsustained ventricular tachycardia occurred more frequently during/posthemodialysis than pre‐/between hemodialysis (63% versus 37%, P=0.015). In adjusted for cardiovascular disease time‐series analysis, nonsustained ventricular tachycardia was preceded by a sudden heart rate increase (by 11.2 [95% CI 10.1–12.3] beats per minute; P<0.0001). During every‐other‐day dialysis, root mean square of the successive normal‐to‐normal intervals had a significant circadian pattern (Mesor 10.6 [ 95% CI 0.9–11.2] ms; amplitude 1.5 [95% CI 1.0–3.1] ms; peak at 02:01 [95% CI 20:22–03:16] am; P<0.0001), which was replaced by a steady worsening on the second day without dialysis (root mean square of the successive normal‐to‐normal intervals −1.41 [95% CI −1.67 to −1.15] ms/24 h; P<0.0001). Conclusions Sudden increase in heart rate during/posthemodialysis is associated with nonsustained ventricular tachycardia. Every‐other‐day hemodialysis preserves circadian rhythm, but a second day without dialysis is characterized by parasympathetic withdrawal. |
| format | Article |
| id | doaj-art-132d2f5e2fb44a3e901808b672a02f19 |
| institution | DOAJ |
| issn | 2047-9980 |
| language | English |
| publishDate | 2019-10-01 |
| publisher | Wiley |
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| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-132d2f5e2fb44a3e901808b672a02f192025-08-20T03:08:26ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802019-10-0181910.1161/JAHA.119.013748Hemodialysis Procedure–Associated Autonomic Imbalance and Cardiac Arrhythmias: Insights From Continuous 14‐Day ECG MonitoringNichole M. Rogovoy0Stacey J. Howell1Tiffany L. Lee2Christopher Hamilton3Erick A. Perez‐Alday4Muammar M. Kabir5Yanwei Zhang6Esther D. Kim7Jessica Fitzpatrick8Jose M. Monroy‐Trujillo9Michelle M. Estrella10Stephen M. Sozio11Bernard G. Jaar12Rulan S. Parekh13Larisa G. Tereshchenko14Oregon Health & Science University Portland OROregon Health & Science University Portland OROregon Health & Science University Portland OROregon Health & Science University Portland OROregon Health & Science University Portland OROregon Health & Science University Portland OROregon Health & Science University Portland ORThe Hospital for Sick Children The University of Toronto Ontario CanadaThe Hospital for Sick Children The University of Toronto Ontario CanadaJohns Hopkins University Baltimore MDJohns Hopkins University Baltimore MDJohns Hopkins University Baltimore MDJohns Hopkins University Baltimore MDThe Hospital for Sick Children The University of Toronto Ontario CanadaOregon Health & Science University Portland ORBackground In patients with end‐stage kidney disease, sudden cardiac death is more frequent after a long interdialytic interval, within 6 hours after the end of a hemodialysis session. We hypothesized that the occurrence of paroxysmal arrhythmias is associated with changes in heart rate and heart rate variability in different phases of hemodialysis. Methods and Results We conducted a prospective ancillary study of the Predictors of Arrhythmic and Cardiovascular Risk in End Stage Renal Disease cohort. Continuous ECG monitoring was performed using an ECG patch, and short‐term heart rate variability was measured for 3 minutes every hour (by root mean square of the successive normal‐to‐normal intervals, spectral analysis, Poincaré plot, and entropy), up to 300 hours. Out of enrolled participants (n=28; age 54±13 years; 57% men; 96% black; 33% with a history of cardiovascular disease; left ventricular ejection fraction 70±9%), arrhythmias were detected in 13 (46%). Nonsustained ventricular tachycardia occurred more frequently during/posthemodialysis than pre‐/between hemodialysis (63% versus 37%, P=0.015). In adjusted for cardiovascular disease time‐series analysis, nonsustained ventricular tachycardia was preceded by a sudden heart rate increase (by 11.2 [95% CI 10.1–12.3] beats per minute; P<0.0001). During every‐other‐day dialysis, root mean square of the successive normal‐to‐normal intervals had a significant circadian pattern (Mesor 10.6 [ 95% CI 0.9–11.2] ms; amplitude 1.5 [95% CI 1.0–3.1] ms; peak at 02:01 [95% CI 20:22–03:16] am; P<0.0001), which was replaced by a steady worsening on the second day without dialysis (root mean square of the successive normal‐to‐normal intervals −1.41 [95% CI −1.67 to −1.15] ms/24 h; P<0.0001). Conclusions Sudden increase in heart rate during/posthemodialysis is associated with nonsustained ventricular tachycardia. Every‐other‐day hemodialysis preserves circadian rhythm, but a second day without dialysis is characterized by parasympathetic withdrawal.https://www.ahajournals.org/doi/10.1161/JAHA.119.013748electrocardiographyheart rate/heart rate variabilityhemodialysistrigger clustersventricular arrhythmia |
| spellingShingle | Nichole M. Rogovoy Stacey J. Howell Tiffany L. Lee Christopher Hamilton Erick A. Perez‐Alday Muammar M. Kabir Yanwei Zhang Esther D. Kim Jessica Fitzpatrick Jose M. Monroy‐Trujillo Michelle M. Estrella Stephen M. Sozio Bernard G. Jaar Rulan S. Parekh Larisa G. Tereshchenko Hemodialysis Procedure–Associated Autonomic Imbalance and Cardiac Arrhythmias: Insights From Continuous 14‐Day ECG Monitoring Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease electrocardiography heart rate/heart rate variability hemodialysis trigger clusters ventricular arrhythmia |
| title | Hemodialysis Procedure–Associated Autonomic Imbalance and Cardiac Arrhythmias: Insights From Continuous 14‐Day ECG Monitoring |
| title_full | Hemodialysis Procedure–Associated Autonomic Imbalance and Cardiac Arrhythmias: Insights From Continuous 14‐Day ECG Monitoring |
| title_fullStr | Hemodialysis Procedure–Associated Autonomic Imbalance and Cardiac Arrhythmias: Insights From Continuous 14‐Day ECG Monitoring |
| title_full_unstemmed | Hemodialysis Procedure–Associated Autonomic Imbalance and Cardiac Arrhythmias: Insights From Continuous 14‐Day ECG Monitoring |
| title_short | Hemodialysis Procedure–Associated Autonomic Imbalance and Cardiac Arrhythmias: Insights From Continuous 14‐Day ECG Monitoring |
| title_sort | hemodialysis procedure associated autonomic imbalance and cardiac arrhythmias insights from continuous 14 day ecg monitoring |
| topic | electrocardiography heart rate/heart rate variability hemodialysis trigger clusters ventricular arrhythmia |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.119.013748 |
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