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Atrial fibrillation in end stage renal disease patients: influence of hemodialysis on P wave duration and atrial dimension

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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.

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Conflict of interest

On behalf of all authors, the corresponding author declares that there is no conflict of interest.

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Authors and Affiliations

  1. Department of Health Sciences, University of Milano-Bicocca and Nephrology Unit San Gerardo Hospital, Via Cadore 48, 20900, Monza (MB), Italy

    S. Genovesi, P. Fabbrini, F. Pieruzzi, E. Galbiati, E. Sironi, M. R. Viganò & A. Stella

  2. Nephrology Unit, Antonio Abate Hospital, Varese, Italy

    D. Pogliani

  3. Nephrology Unit, Beata Vergine Hospital, Mendrisio, Switzerland

    G. Bonforte

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  1. S. Genovesi
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  2. P. Fabbrini
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  3. F. Pieruzzi
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  4. E. Galbiati
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  5. E. Sironi
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  6. D. Pogliani
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  7. G. Bonforte
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  8. M. R. Viganò
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  9. A. Stella
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Correspondence to S. Genovesi.

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Genovesi, S., Fabbrini, P., Pieruzzi, F. et al. Atrial fibrillation in end stage renal disease patients: influence of hemodialysis on P wave duration and atrial dimension. J Nephrol 28, 615–621 (2015). https://doi.org/10.1007/s40620-014-0131-7

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  • DOI: https://doi.org/10.1007/s40620-014-0131-7

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