A pilot study in hemodialysis of an electrophysiological tool to measure sudden cardiac death risk.
BACKGROUND
The hemodialysis procedure may play a role in the elevated risk of sudden cardiac death seen in hemodialysis patients.


METHODS
Microvolt T wave alternans, a promising noninvasive electrophysiological test developed to measure sudden cardiac death risk, was used to test the hypotheses that high-risk hemodialysis patients commonly manifest cardiac electrophysiology that is associated with higher sudden death risk in nondialysis patients and that the hemodialysis procedure modifies cardiac electrophysiology in a manner predisposing to malignant ventricular arrhythmias. To test this hypothesis, microvolt T wave alternans tracings were done in 9 patients before and immediately after an early week hemodialysis session.


RESULTS
7 of 9 individuals had non-negative (i.e. higher risk) tracings either before or after hemodialysis. 2 of 4 subjects with tracings initially negative before hemodialysis became non-negative after hemodialysis.


CONCLUSIONS
This pilot study provides the first objective preliminary evidence using microvolt T wave alternans that high-risk hemodialysis patients commonly exhibit abnormal cardiac repolarization and that hemodialysis treatments can acutely alter repolarization in a potentially harmful manner.
Friedman
A N
AN
Division of Nephrology, Indiana University, Indianapolis, IN, USA. allfried@iupui.edu
Groh
W J
WJ
Das
M
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016757:Death, Sudden, Cardiac / Q000209:etiology*; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011237:Predictive Value of Tests; D006435:Renal Dialysis / Q000009:adverse effects*; D018570:Risk Assessment; D014693:Ventricular Fibrillation / Q000209:etiology*