T‐Wave Alternans, Heart Rate Turbulence, and Ventricular Ectopy in Standard versus Daily Hemodialysis: Results from the FHN Daily Trial. Issue 6 (28th March 2016)

• Record Type: Journal Article
• Authors: Kaplan, Rachel M.; Herzog, Charles A.; Larive, Brett; Subacius, Haris; Nearing, Bruce D.; Verrier, Richard; Passman, Rod S.
• Is Part Of: Annals of noninvasive electrocardiology. Volume 21:Issue 6(2016:Nov.)
• Page Start: 566
• Page End: 571
• Publication Date: 2016-03-28
• Subjects: dialysis -- heart rate turbulence -- sudden cardiac death -- T‐wave alternans; Electrocardiography -- Periodicals; Arrhythmia -- Periodicals; 616.1207547
• DOI: 10.1111/anec.12354
• Languages: English
• ISSNs: 1082-720X

Abstract

Abstract : Background: Hemodialysis (HD) patients are at high risk of sudden cardiac death (SCD). HD 6‐times/week (6x/wk) may reduce SCD risk compared to usual 3‐times/week HD (3x/wk) by mechanisms unknown. T‐wave alternans (TWA), heart rate turbulence (HRT), and ventricular ectopy (VE) are elevated in HD patients, but their response to 6x/wk HD has not been assessed. Methods: Baseline and 1‐year Holter recordings were analyzed from enrollees in the Frequent Hemodialysis Network Daily Trial, a randomized trial comparing 3x/wk to 6x/wk in 245 chronic HD patients. TWA, HRT, and VE were assessed using MARS software. Results: Sixty‐eight patients (34 with 6x/wk) had complete baseline and 1‐year Holter recordings. Mean age was 50 ± 13 years and 38% were female. Maximum TWA in the 3x/wk and 6x/wk groups were 52.4 μV at baseline and 51.2 μV at 1‐year versus 54.0 and 49.9 μV, respectively (P = 0.28). The proportion of abnormal HRT (scores of 1 or 2) in the 3x/wk group decreased from 65% to 56% at 1‐year versus 53% to 53% in the 6x/wk group (P = 0.58). Mean %VE changed from 1.6% to 2.9% in the 3x/wk group from baseline to 1‐year and from 2.1% to 3.7% in the 6x/wk group (P = 0.85). Conclusions: There were no significant differences in HRT or VE at 1‐year in chronic HD patients randomized to 6x/wk versus 3x/wk and a trend in TWA reduction. Additional studies are needed to evaluate the impact and mechanisms of SCD in HD.