title: Severe coronary stenosis is an important factor for induction and lengthy persistence of ventricular arrhythmias during and after hemodialysis.
abstract: BACKGROUND
  Ventricular arrhythmias have been shown to be the major cause of sudden cardiac death in hemodialysis (HD) patients. We investigated whether angiographic coronary stenosis was responsible for the induction of ventricular arrhythmias in HD patients.
  
  
  METHODS
  HD patients (n = 150) showing ischemic signs in exercise electrocardiography or echocardiography were divided into 2 groups: the stenotic group (n = 61), with significant coronary stenosis (> or =75% in diameter), and the nonstenotic group (n = 89), without significant coronary stenosis on coronary angiography. Severity of ventricular arrhythmias was evaluated by means of ambulatory 24-hour Holter monitoring in HD patients with and without significant coronary stenosis.
  
  
  RESULTS
  The frequency of ventricular premature contractions and prevalence of patients with Lown class 4 ventricular arrhythmias were significantly greater in the stenotic than nonstenotic group during HD and for 12 hours after HD (P < 0.03). In the stenotic group, a significantly greater frequency of ventricular premature contractions and prevalence of patients with complex arrhythmias were observed during HD (1.33% and 31.1%, respectively) compared with before HD (0.50% and 11.5%, respectively), and the high incidence persisted for 6 hours after HD. In the nonstenotic group, a slightly increased incidence was observed only during HD compared with before HD. Multivariate analysis showed only coronary stenosis (odds ratio, 5.69; P = 0.041) as an independent and significant factor for the induction of complex arrhythmias.
  
  
  CONCLUSIONS
  These data clearly indicate that severe coronary stenosis, which may cause myocardial ischemia, is an important factor for the induction and lengthy persistence of ventricular arrhythmias during and after HD.
authors.affiliation: Cardiovascular Center and Department of Nephrology, Nagoya Kyoritu Hospital, Nagoya, Japan. ykitano@kaikou.or.jp
authors.forename: Yukari
authors.initials: Y
authors.lastname: Kitano
authors.forename: Hirotake
authors.initials: H
authors.lastname: Kasuga
authors.forename: Midoriko
authors.initials: M
authors.lastname: Watanabe
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Takahashi
authors.forename: Koichi
authors.initials: K
authors.lastname: Ibuki
authors.forename: Yasumasa
authors.initials: Y
authors.lastname: Kawade
authors.forename: Kaoru
authors.initials: K
authors.lastname: Yasuda
authors.forename: Shigejiro
authors.initials: S
authors.lastname: Iwashima
authors.forename: Takanobu
authors.initials: T
authors.lastname: Toriyama
authors.forename: Seiichi
authors.initials: S
authors.lastname: Matuo
authors.forename: Hirohisa
authors.initials: H
authors.lastname: Kawahara
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000145:classification / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology; D003925:Diabetic Angiopathies / Q000150:complications / Q000453:epidemiology; D003928:Diabetic Nephropathies / Q000150:complications / Q000453:epidemiology; D004562:Electrocardiography; D015716:Electrocardiography, Ambulatory; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000209:etiology / Q000503:physiopathology; D015995:Prevalence; D006435:Renal Dialysis; D012307:Risk Factors; D013599:Systole; D017180:Tachycardia, Ventricular / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D018879:Ventricular Premature Complexes / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology