Symptomatic atrial arrhythmias in hemodialysis patients

Background/Aims: Cardiac arrhythmias are frequent in hemodialysis patients and can interrupt treatment. However, the frequency and risk factors have r emained unclear because previous reports of arrhythmias in dialysis patient s have usually been continuous-monitoring studies that looked at all cardia c ectopy regardless of its seriousness. Methods: We reviewed retrospectivel y only symptomatic atrial arrhythmias in a population of 106 maintenance he modialysis patients over three years, in order to estimate their actual fre quency and any risk factors. Results: Ten patients, seven men and three wom en, required treatment for atrial arrhythmias (9.4%): four for supraventric ular tachycardia, three for atrial flutter, and three for atrial fibrillati on. Their mean age was 53.7 +/- 6.1 years; five of them were less than or e qual to 40 years. Seven arrhythmias were new, three were recurrences. All b ut one occurred between 3 and 4 hours of hemodialysis, and dialysis had to be stopped in nine instances. There was no pattern of hypotensive episodes preceding the arrhythmias. Mean serum K+ drawn at the time of the arrhythmi as was 3.8 +/- 0.2 mEq/L. Mean plasma intact parathormone was 1128 +/- 417 pg/mL, compared to 454 +/- 58 pg/mL for our entire hemodialysis population (p = .0036). Subsequent echocardiograms showed abnormalities in 9/10 patien ts: five had left ventricular hypertrophy, six had left atrial enlargement, five had valvular lesions (four mitral regurgitation; one aortic incompete nce), and three had ejection fractions <50%. There were four deaths in thes e patients over the next 14 months, but probably only one was cardiac. Conc lusions: Serious atrial arrhythmias are common in a hemodialysis population . Risk factors for symptomatic atrial arrhythmias in hemodialysis patients may include hyperparathyroidism and echocardiographic findings of chamber e nlargement, valvular lesions, or ventricular dysfunction.