Author + information
- Received June 1, 2017
- Revision received July 31, 2017
- Accepted August 2, 2017
- Published online March 19, 2018.
- Frederic Sacher, MD, PhDa,b,∗ (, )
- Laurence Jesel, MD, PhDc,
- Claire Borni-Duval, MDc,
- Valerie De Precigout, MDb,
- Frédéric Lavainne, MDd,
- Jean-Philippe Bourdenx, MDe,
- Atman Haddj-Elmrabet, MDf,
- Bruno Seigneuric, MDg,
- Adrien Keller, MDh,
- Julien Ott, MDi,
- Helene Savel, MScj,
- Yahsou Delmas, MD, PhDb,
- Dorothée Bazin-kara, MDc,
- Nicolas Klotz, MDa,b,
- Sylvain Ploux, MD, PhDa,b,
- Sébastien Buffler, MDi,
- Philippe Ritter, MDa,b,
- Virginie Rondeau, PhDj,
- Pierre Bordachar, MD, PhDa,b,
- Claire Martin, MD, PhDa,b,
- Antoine Deplagne, MDh,
- Sylvain Reuter, MDe,
- Michel Haissaguerre, MDa,b,
- Jean-Baptiste Gourraud, MD, PhDd,
- Cécile Vigneau, MDf,
- Philippe Mabo, MDf,
- Philippe Maury, MDg,
- Thierry Hannedouche, MD, PhDc,
- Antoine Benard, MD, PhDj and
- Christian Combe, MD, PhDb,k
- aIHU LIRYC — Universite de Bordeaux, INSERM 1045, Bordeaux, France
- bCentre Hospitalier Universitaire de Bordeaux, Bordeaux, France
- cHôpitaux Universitaires de Strasbourg and Medical School of Strasbourg, Strasbourg, France
- dCentre Hospitalier Universitaire de Nantes, Nantes, France
- eClinique Saint-Augustin, Bordeaux, France
- fCentre Hospitalier Universitaire de Rennes, Rennes, France
- gCentre Hospitalier Universitaire de Toulouse, Toulouse, France
- hCentre Hospitalier de Libourne, Libourne, France
- iCentre Hospitalier de Haguenau, Haguenau, France
- jUnité de Soutien Méthodologique à la Recherche Clinique, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
- kUnité INSERM 1026, Universite de Bordeaux, Bordeaux, France
- ↵∗Address for correspondence:
Dr. Frederic Sacher, Service de Rythmologie, Hopital Cardiologique du Haut Leveque, Avenue de Magellan, 33604 Pessac Cedex, France.
Objectives The aim of this study was to identify using implantable loop recorder (ILR) monitoring the mechanisms leading to sudden death (SD) in patients undergoing hemodialysis (HD).
Background SD accounts for 11% to 25% of death in HD patients.
Methods Continuous rhythm monitoring was performed using the remote monitoring capability of the ILR device in patients undergoing HD at 8 centers. Clinical, biological, and technical HD parameters were recorded and analyzed.
Results Seventy-one patients (mean age 65 ± 9 years, 73% men) were included. Left ventricular ejection fraction was <50% in 16%. Twelve patients (17%) had histories of atrial fibrillation or flutter at inclusion. During a mean follow-up period of 21.3 ± 6.9 months, 16 patients died (14% patient-years), 7 (44%) of cardiovascular causes. Four SDs occurred, with progressive bradycardia followed by asystole. The incidence of patients presenting with significant conduction disorder and with ventricular arrhythmia was 14% and 9% patient-years, respectively. In multivariate survival frailty analyses, a higher risk for conduction disorder was associated with plasma potassium >5.0 mmol/l, bicarbonate <22 mmol/l, hemoglobin >11.5 g/dl, pre-HD systolic blood pressure >140 mm Hg, the longer interdialytic period, history of coronary artery disease, previous other arrhythmias, and diabetes mellitus. A higher risk for ventricular arrhythmia was associated with potassium <4.0 mmol/l, no antiarrhythmic drugs, and previous other arrhythmias. With ILR monitoring, de novo atrial fibrillation or flutter was diagnosed in 14 patients (20%).
Conclusions ILR may be considered in HD patients prone to significant conduction disorders, ventricular arrhythmia, or atrial fibrillation or flutter to allow early identification and initiation of adequate treatment. Therapeutic strategies reducing serum potassium variability could decrease the rate of SD in these patients. (Implantable Loop Recorder in Hemodialysis Patients [RYTHMODIAL]; NCT01252823)
This research was supported by a national health care grant (PHRC 2010-A00966-33), IHU LIRYC ANR-10-IAHU-04. Implantable loop recorders (Reveal XT, Medtronic, Minneapolis, Minnesota) used in this study were provided free of charge by Medtronic. Drs. Sacher, Ploux, Reuter, Klotz, and Ritter have received speaking honoraria from Medtronic France. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received June 1, 2017.
- Revision received July 31, 2017.
- Accepted August 2, 2017.
- 2018 American College of Cardiology Foundation
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