title: Maps of Ventricular Activation Time (VAT) Differences in Children on Peritoneal Dialysis - a Pilot Study.
abstract: BACKGROUND
  Decrement of glomerular filtration rate leads to many serious complications that cause both functional and structural impairments of the other organs. Long-term clinical observations of children and teenagers with end-stage renal disease (ESRD) showed that more than one third of those patients manifested various cardio-vascular conditions. The aim of the study was to analyze possible disturbances in the heart ventricular conduction system by using a technique of ventricular activation time (VAT) differences in ESRF children on peritoneal dialysis (PD) with normal electrocardiogram (ECG) examinations.
  
  
  METHODS
  The study group comprised 10 ESRD children (mean age: 13.6 ± 2.31 years) on peritoneal dialysis - group I. The control group (group II) consisted of 26 age-matched healthy children with no clinical evidence of renal or cardiac disease and with normal 12-lead ECG recordings. Each of the ESRD patients was also subjected to the standard ECG examination. In order to capture possible heart conduction abnormalities, body surface potential mapping (BSPM) recordings were performed in PD patients between the successive dwells ('on empty abdomen') with a HPM-7100 Fukuda Denshi system. Based on the source ECG data, the original technique of a VAT difference map was then applied.
  
  
  RESULTS
  Differences between VAT values for the two examined groups of children, controls and ESRD patients on PD, were significantly pronounced in the region of the right upper anterior thorax, the entire left thorax and nearly in the total back. Such a pattern of VAT delays indicates a pathological electric transmission in the intraventricular conduction system of the left anterior fascicle of His bundle.
  
  
  CONCLUSIONS
  1. VAT maps (isochrone maps) can be useful to detect abnormal spreading and depolarization through the heart ventricles. 2. Map of VAT value differences makes it possible to identify early disturbances in the left His bundle branch in ESRD children treated with peritoneal dialysis regardless of normal 12-lead ECG. 3. Further studies on a larger group of children with ESRD on PD are required to verify the preliminary observations presented herein.
authors.affiliation: Department of Pathophysiology, Wroclaw Medical University, Poland.
authors.forename: Krystyna
authors.initials: K
authors.lastname: Laszki-Szcząchor
authors.affiliation: Department of Pediatric Nephrology, Wroclaw Medical University, Poland.
authors.forename: Dorota
authors.initials: D
authors.lastname: Polak-Jonkisz
authors.affiliation: Department of Pediatric Nephrology, Wroclaw Medical University, Poland.
authors.forename: Danuta
authors.initials: D
authors.lastname: Zwolińska
authors.affiliation: Department of Physiology, Wroclaw Medical University, Wroclaw, Poland.
authors.forename: Ewa
authors.initials: E
authors.lastname: Salomon
authors.affiliation: Department of Pathophysiology, Wroclaw Medical University, Poland.
authors.forename: Henryk
authors.initials: H
authors.lastname: Filipowski
authors.affiliation: Department of Pathophysiology, Wroclaw Medical University, Poland.
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Sobieszczańska
mesh_terms: D000293:Adolescent; D018780:Body Surface Potential Mapping; D016022:Case-Control Studies; D002648:Child; D004562:Electrocardiography; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000503:physiopathology* / Q000628:therapy*; D008297:Male; D010530:Peritoneal Dialysis; D010865:Pilot Projects; D016276:Ventricular Function / Q000502:physiology
keywords: BSPM; End-stage renal disease (ESRD); VAT maps; children; peritoneal dialysis