1. Implantable Loop Recorder Monitoring and the Incidence of Previously Unrecognized Atrial Fibrillation in Patients on Hemodialysis
- Author
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Bruce A. Koplan, Wolfgang C. Winkelmayer, Alexandru I. Costea, Prabir Roy-Chaudhury, James A. Tumlin, Vijay Kher, Don E. Williamson, Saurabh Pokhariyal, David M. Charytan, Don Williamson, MD, Prabir Roy-Chaudhury, MD, James Tumlin, MD, Vijay Kher, MD, Vikranth Reddy, MD, Kowdle Chandrasekhar Prakash, MD, David Charytan, MD MSc, Suresh Chandra Tiwari, MD, Saurabh Pokhariyal, MD, Amber Podoll, MD, Sanjeev Jasuja, MD, G. Leslie Walters, MD, Kraig Wangsnes, MD, Alexandru Costea, MD, Selcuk Tombul, MD, Balbir Singh, MD, Brajesh Mishra, MD, Sachin Yalagudri, MD, Abhijeet Shelke, MD, Calambur Narasimhan, MD, A.M. Karthigesan, MD, Abraham Oomman, MD, K P Pramod Kumar, MD, Bruce Koplan, MD, Upendra Kaul, MD, Tapan Ghose, MD, Ripen Gupta, MD, Arvind Sethi, MD, Nikhil Kumar, MD, Ramesh Hariharan, MD, Rajnish Sardana, MD, Arif Wahab, MD, N.N. Khanna, MD, Mark Smith, MD, Suresh Kamath, MD, Claude Galphin, MD, Puneet Sodhi, MD, Rajsekara Chakravarthy, MD, Subba Rao Budithi, MD, Finnian McCausland, MB, MMSc, Sanjeev Gulati, MD, Munawer Dijoo, MD, Upendra Singh, MD, Salil Jain, MD, Vishal Saxena, MD, Gaurav Sagar, MD, David Charytan, MD, MSc, Rachel Fissell, MD, Robert Foley, MD, Charles A. Herzog, MD, Peter A. McCullough, MD, John D. Rogers, MD, James A. Tumlin, MD, Peter Zimetbaum, MD, Manish Assar, MD, Mark Kremers, MD, and Wolfgang C. Winkelmayer, MD, ScD
- Subjects
arrhythmias ,atrial fibrillation ,hemodialysis ,kidney failure ,end stage kidney diseae (ESKD) ,implantable loop recorder ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Introduction: Atrial fibrillation (AF) is common in patients with kidney failure on hemodialysis (KF-HD). We determined both AF incidence and burden in patients with KF-HD using implantable loop recorder (ILR) monitoring. Methods: Patients with KF-HD were enrolled and received an ILR. In 6 monitoring months, the incidence of AF events lasting ≥6 minutes was captured. Demographic, clinical, and dialysis characteristics were collected, and associations with incident AF were estimated using negative binomial regression models and expressed as incidence rate ratios and 95% CIs. Results: We enrolled 66 patients with KF-HD (mean age = 56 years, 70% male); 59 (90%) were without previously diagnosed AF. AF lasting ≥6 minutes was detected in 18 of 59 subjects (31%) without previously diagnosed AF and in 5 of 7 subjects (71%) with a previous AF diagnosis. Among the 23 with detected AF, episodes were present on 16% of patient days. Although 14 of 23 patients (61%) had AF on 2.5 vs. 2.5 mEq/l: incidence rate ratio = 0.62; 95% CI, 0.48–0.80) was associated with lower AF risk whereas higher dialysate bicarbonate concentrations (>35 vs. 35 mEq/l: incidence rate ratio = 3.18; 95% CI, 1.13–8.94) were associated with higher AF risk. Conclusion: New AF was detected in approximately one-third of patients with KF-HD. AF affects a substantial proportion of patient days and may be an underappreciated cause of stroke in KF-HD.
- Published
- 2022
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