title: Atrial fibrillation in end stage renal disease patients: influence of hemodialysis on P wave duration and atrial dimension.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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 ± 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.
  
  
  RESULTS
  Patients with the shortest dialysis vintage showed the shortest Pwd [131.2 ± 11.0 (HD1) vs. 139.8 ± 11.7 (HD2), 142.1 ± 7.2 (HD3), 152.3 ± 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 ± 14.0-152 ± 17.0 ms, p < 0.001), that was correlated to modifications of K(+) concentration (R = 0.8, p < 0.0001).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Health Sciences, University of Milano-Bicocca and Nephrology Unit San Gerardo Hospital, Via Cadore 48, 20900, Monza (MB), Italy. simonetta.genovesi@unimib.it.
authors.forename: S
authors.initials: S
authors.lastname: Genovesi
authors.affiliation: Department of Health Sciences, University of Milano-Bicocca and Nephrology Unit San Gerardo Hospital, Via Cadore 48, 20900, Monza (MB), Italy.
authors.forename: P
authors.initials: P
authors.lastname: Fabbrini
authors.affiliation: Department of Health Sciences, University of Milano-Bicocca and Nephrology Unit San Gerardo Hospital, Via Cadore 48, 20900, Monza (MB), Italy.
authors.forename: F
authors.initials: F
authors.lastname: Pieruzzi
authors.affiliation: Department of Health Sciences, University of Milano-Bicocca and Nephrology Unit San Gerardo Hospital, Via Cadore 48, 20900, Monza (MB), Italy.
authors.forename: E
authors.initials: E
authors.lastname: Galbiati
authors.affiliation: Department of Health Sciences, University of Milano-Bicocca and Nephrology Unit San Gerardo Hospital, Via Cadore 48, 20900, Monza (MB), Italy.
authors.forename: E
authors.initials: E
authors.lastname: Sironi
authors.affiliation: Nephrology Unit, Antonio Abate Hospital, Varese, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Pogliani
authors.affiliation: Nephrology Unit, Beata Vergine Hospital, Mendrisio, Switzerland.
authors.forename: G
authors.initials: G
authors.lastname: Bonforte
authors.affiliation: Department of Health Sciences, University of Milano-Bicocca and Nephrology Unit San Gerardo Hospital, Via Cadore 48, 20900, Monza (MB), Italy.
authors.forename: M R
authors.initials: MR
authors.lastname: Viganò
authors.affiliation: Department of Health Sciences, University of Milano-Bicocca and Nephrology Unit San Gerardo Hospital, Via Cadore 48, 20900, Monza (MB), Italy.
authors.forename: A
authors.initials: A
authors.lastname: Stella
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006329:Heart Conduction System / Q000503:physiopathology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D006435:Renal Dialysis / Q000009:adverse effects*
keywords: Atrial dimension; Atrial fibrillation; End stage renal disease; Hemodialysis; P wave duration; Potassium