Atrial fibrillation in end stage renal disease patients: influence of hemodialysis on P wave duration and atrial dimension

作者：Genovesi S^*; Fabbrini P; Pieruzzi F; Galbiati E; Sironi E; Pogliani D; Bonforte G; Vigano M R; Stella A

来源：Journal of Nephrology, 2015, 28(5): 615-621.

DOI：10.1007/s40620-014-0131-7

• End stage renal disease
• Hemodialysis
• Atrial fibrillation
• Atrial dimension
• P wave duration
• Potassium

Prevalence and incidence of atrial fibrillation (AF) are high in hemodialysis (HD) patients. Intra-atrial conduction velocity slowing plays an important role in AF onset. The aim of our study was to measure P wave duration (Pwd), expression of intra-atrial conduction velocity, in HD patients with and without a history of AF.
The study was performed in 47 end stage renal disease (ESRD) patients, subdivided into four groups: 19 patients within the first 6 months from starting HD therapy (HD1); the same patients studied 18 +/- A 3 months later (HD2); patients with no history of AF and long dialytic age (HD3, n = 13); and patients with sinus rhythm but history of AF (HDAF, n = 15); and 18 healthy controls. In all patients P wave high resolution recording and electrolyte plasma values were obtained before and after a HD session, and atrial diameter was assessed by echocardiography.
Patients with the shortest dialysis vintage showed the shortest Pwd [131.2 +/- A 11.0 (HD1) vs. 139.8 +/- A 11.7 (HD2), 142.1 +/- A 7.2 (HD3), 152.3 +/- A 15.0 (HDAF) ms; p < 0.05], while Pwd was prolonged in patients with AF history when compared to all other groups (p < 0.03). At multivariate analysis atrial dimension was independently related to Pwd (R = 0.40, p < 0.02). HD session induced a significant increase of Pwd (141 +/- A 14.0-152 +/- A 17.0 ms, p < 0.001), that was correlated to modifications of K+ concentration (R = 0.8, p < 0.0001).
HD therapy prolongs Pwd. HD patients with a history of AF have prolonged Pwd compared to patients without, suggesting that increased Pwd is a marker of AF risk in patients with ESRD. HD session acutely increases Pwd, creating conditions favoring AF onset.

• 出版日期2015-10