Hemodialysis-Induced P-Wave Signal-Averaged Electrocardiogram Alterations Are Indicative of Vulnerability to Atrial Arrhythmias

Kentaro Shimada; Takeshi Tomita; Yuji Kamijo; Makoto Higuchi; Kenichi Ito; Yoichi Koizumi; Kazuya Yamamoto; Kazunori Aizawa; Megumi Koshikawa; Hiroki Kasai; Atsushi Izawa; Yusuke Miyashita; Setsuo Kumazaki; Jun Koyama; Uichi Ikeda

doi:10.1253/circj.CJ-11-1000

Arrhythmia/Electrophysiology

Hemodialysis-Induced P-Wave Signal-Averaged Electrocardiogram Alterations Are Indicative of Vulnerability to Atrial Arrhythmias

Kentaro Shimada, Takeshi Tomita, Yuji Kamijo, Makoto Higuchi, Kenichi Ito, Yoichi Koizumi, Kazuya Yamamoto, Kazunori Aizawa, Megumi Koshikawa, Hiroki Kasai, Atsushi Izawa, Yusuke Miyashita, Setsuo Kumazaki, Jun Koyama, Uichi Ikeda

Author information

Kentaro Shimada
Department of Cardiovascular Medicine, Shinshu University School of Medicine
Takeshi Tomita
Department of Cardiovascular Medicine, Shinshu University School of Medicine
Yuji Kamijo
Department of Nephrology Internal Medicine, Shinshu University School of Medicine
Makoto Higuchi
Department of Nephrology Internal Medicine, Shinshu University School of Medicine
Kenichi Ito
Komoro Kousei Hospital
Yoichi Koizumi
Komoro Kousei Hospital
Kazuya Yamamoto
Iida Municipal Hospital
Kazunori Aizawa
Department of Cardiovascular Medicine, Shinshu University School of Medicine
Megumi Koshikawa
Department of Cardiovascular Medicine, Shinshu University School of Medicine
Hiroki Kasai
Department of Cardiovascular Medicine, Shinshu University School of Medicine
Atsushi Izawa
Department of Cardiovascular Medicine, Shinshu University School of Medicine
Yusuke Miyashita
Department of Cardiovascular Medicine, Shinshu University School of Medicine
Setsuo Kumazaki
Department of Cardiovascular Medicine, Shinshu University School of Medicine
Jun Koyama
Department of Cardiovascular Medicine, Shinshu University School of Medicine
Uichi Ikeda
Department of Cardiovascular Medicine, Shinshu University School of Medicine

Keywords: Atrial fibrillation, Hemodialysis, P-wave signal-averaged electrocardiogram

JOURNAL FREE ACCESS

2012 Volume 76 Issue 3 Pages 612-617

DOI https://doi.org/10.1253/circj.CJ-11-1000

View "Advance Publication" version (January 11, 2012).

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Abstract

Background: Atrial fibrillation (AF) is the most common supraventricular arrhythmia, often occurring during hemodialysis (HD). Prolongation of the total filtered P-wave duration (PWD) and reduction of the root mean square voltages for the last 20ms of the P wave (RMS20) on a P-wave signal-averaged electrocardiogram (P-SAECG) are predictors of AF. We investigated whether HD induces alterations of P-SAECG, and determined the influential factors. Methods and Results: Thirty-three end-stage kidney disease patients (66.7±12.6 years, 23 males) undergoing maintenance HD were enrolled in this study. Digital ambulatory P-SAECG monitoring and laboratory examination of serum proteins and ions were carried out before, during, and after the HD sessions. Data were analyzed by multiple regression analysis. PWD was significantly prolonged, and RMS20 significantly reduced, during HD. These values recovered after completion of HD. Multiple regression analysis showed that prolongation of PWD significantly correlated with HD duration and the rate of removal of body fluid. On the other hand, RMS20 significantly correlated with HD duration and blood urea nitrogen variation. Conclusions: HD resulted in prolongation of PWD and reduction of RMS20, indicating the vulnerability of HD patients to AF. These P-SAECG changes correlated with HD duration and the rate of removal of the body fluid. These findings underline the importance of the control of dialysis variables in the prevention of atrial arrhythmias following HD. (Circ J 2012; 76: 612-617)

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