Background: Sudden cardiac death (SCD) is a major driver of mortality in
patients with end-stage renal disease (ESRD) on hemodialysis (HD). The
degree to which ventricular arrhythmias (VA) play a role in SCD in ESRD
patients is unclear. Objective: Use cardiac implantable electronic
devices (CIEDs) to clarify VA burden in ESRD patients overall and in
relation to interdialytic cycle. Methods: We identified 44 patients at a
single academic center with CIEDs, 22 on HD, along with 22 age- and
sex-matched controls. Device interrogations from 11/13/14 – 4/8/19 were
reviewed. Results: Overall, there were no differences in HD patients and
controls in adjusted overall event rate (HD 9.81 x 10-5 ± 1.5 x 10-3
events/patient-hours vs control 3.71 x 10-5 ± 9.1 x 10-4
events/patient-hours, p = 0.902), or proportion of patients experiencing
VA event (HD 45.4% vs control 63.6%, p = 0.226). There was no
difference in ventricular pacing burden. Controls were more likely to
require device therapy for VT/VF episodes (total ATP episodes 2/38 in HD
vs 10/22 in controls, p < 0.01, total ICD shocks 10/38 in HD
vs 17/22 in controls, p < 0.01). HD patients were most likely
to experience VA within 12-hours of HD completion (p < 0.01),
and the vast majority of events were NSVT. Conclusion: VA and
ventricular pacing burden was similar by CIED analysis between groups.
In HD patients, VA were likely to occur within the first 12 hours
post-dialysis, were primarily NSVT, and were unlikely to require device
therapy.
Effects of Left Ventricular Assist Device Therapy on Ventricular Arrhythmias