Nephrology Dialysis Transplantation, Vol 13, Issue 3 668-673, Copyright © 1998 by Oxford University Press
M Morales, C Gremigni, P Dattolo, M Piacenti, T Cerrai, A Fazi, G Pelosi, R Vergassola and Q Maggiore
Background: Late potential (LP) on the signal-averaged
electrocardiogram (SAECG) are predictive of malignant ventricular
arrhythmias and sudden cardiac death in patients with ischaemic and
non-ischaemic cardiomyopathy. Cardiac dysfunction, both regional and
global, as well as supraventricular and ventricular arrhythmias are
reported in a high percentage of patients with end-stage renal failure
(ESRF). The aim of the study was to assess the prevalence of LP and the
effects of haemodialysis on the SAECG of ESRF patients.
Methods: SAECG was recorded immediately before and
within 30 min after the end of dialysis in 48 patients in sinus rhythm,
free of conduction disturbances on ECG and of signs of congestive heart
failure. Serum electrolytes were sampled together with the SAECG
recordings. An echo-Doppler exam was performed within 2 weeks of the study.
SAECGs were adequate for analysis in 45/48 patients. LP were present when
at least two of the following criteria were fulfilled: QRS duration
⩽115 ms, LAS40⩽38ms, RMS40⩾38 &mgr;V at 40 Hz
high pass bidirectional filter, and noise <0.7 &mgr;V.
Results: LP were detected in 12/45 patients (25%) on
the SAECG before dialysis; of these 12 patients, seven had a history of a
previous myocardial infarction and two had documented coronary artery
disease (CAD). A significant greater wall motion score index - calculated
on a 16 segment model - was reported in patients with LP
(1.20±0.20 vs 1.01±0.03,
P<0.01), while left ventricular mass was comparable in the two
groups of patients. At the end of dialysis, a significant prolongation of
fQRS duration was found both at 25 and 40 Hz filters (from 98±11
to 106±16 ms and from 97±12 s to 102±13
ms, respectively, P<0.001). A significant inverse relationship was
seen between the percentage of dialysis-induced serum potassium reduction
and fQRS changes at 40 Hz (r=-0.68, P<0.001).
Conclusions: LP were detected in a significant
proportion of dialysis patients, probably related to underlying CAD with
left ventricular dysfunction. Prolongation of fQRS afer dialysis could be
explained by the acute reduction in serum potassium levels. Key
words: echocardiography; haemodialysis; potassium;
signal-averaged ECG; ventricular function
ORIGINAL ARTICLES
Signal-averaged ECG abnormalities in haemodialysis patients. Role of dialysis
CNR Clinical Phsyiology Institute, Via Paolo Savi 8, I-56100 Pisa, Italy; Nephrology and Dialysis Unit, S.M. Annunziata Hospital, Florence, Italy; Corresponding author
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