title: Hemodialysis-induced P-wave signal-averaged electrocardiogram alterations are indicative of vulnerability to atrial arrhythmias.
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 20 ms 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.
  
  
  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.
authors.affiliation: Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Shimada
authors.forename: Takeshi
authors.initials: T
authors.lastname: Tomita
authors.forename: Yuji
authors.initials: Y
authors.lastname: Kamijo
authors.forename: Makoto
authors.initials: M
authors.lastname: Higuchi
authors.forename: Kenichi
authors.initials: K
authors.lastname: Ito
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Koizumi
authors.forename: Kazuya
authors.initials: K
authors.lastname: Yamamoto
authors.forename: Kazunori
authors.initials: K
authors.lastname: Aizawa
authors.forename: Megumi
authors.initials: M
authors.lastname: Koshikawa
authors.forename: Hiroki
authors.initials: H
authors.lastname: Kasai
authors.forename: Atsushi
authors.initials: A
authors.lastname: Izawa
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Miyashita
authors.forename: Setsuo
authors.initials: S
authors.lastname: Kumazaki
authors.forename: Jun
authors.initials: J
authors.lastname: Koyama
authors.forename: Uichi
authors.initials: U
authors.lastname: Ikeda
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000209:etiology / Q000517:prevention & control*; D004198:Disease Susceptibility; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects* / Q000379:methods