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Introduction and Objectives: Although bundle branch block (BBB) is regarded as a frequent finding, data on its prevalence are scarce in the general population and nonexistent in patients on dialysis. The aims of this study were to determine the prevalence of complete BBB in patients starting dialysis, to identify factors associated with its presence and, secondarily, to explore its association with mortality and the occurrence of cardiovascular events., Methods: The study involved patients who started dialysis at our institution between November 1, 2003 and December 31, 2006. All underwent cardiological evaluation at the start of treatment. The presence of BBB was determined and its relationship with clinical factors and biochemical and echocardiographic parameters was examined. Patients were followed up until November 30, 2007., Results: The study included 211 patients (age 65.05+/-15.7 years; 56.4% male). Of these, 24 (11.4%) presented with BBB: 6 (2.8%) with left BBB and 18 (8.5%) with right BBB. Age (odds ratio [OR]=1.05; 95% confidence interval [CI], 1.008-1.113; P=.02) and body mass index (OR=1.12; 95% CI, 1.019-1.234; P=.02) were independently associated with BBB. During a mean follow-up period of 23.7+/-12.9 months, patients who presented with left BBB showed a clear trend towards a poorer outcome than those without a conduction defect., Conclusions: The prevalence of BBB was high in patients starting dialysis and greater than that observed in the general population. Its presence was independently associated with older age and obesity. During the mean follow-up period of 2 years, patients with left BBB demonstrated a trend towards a poor prognosis.

Introduction and Objectives: Although atrial fibrillation (AF) is the most commonly occurring arrhythmia in the general population and is a serious health problem, its incidence in patients on hemodialysis is unknown. Our objectives were to determine the incidence of AF in our hemodialysis patients, to investigate factors that predispose to its occurrence, and to assess the clinical implications of AF., Methods: In total, 164 patients in sinus rhythm (SR) were followed for seven years. The occurrence of AF and its influence on mortality and on the occurrence of thromboembolic events were recorded., Results: In a mean follow-up period of 47 (29.5) months (i.e., 643.2 patient-years), 20 patients developed AF (3.1 per 100 patient-years). It was not possible to identify factors that predisposed to the arrhythmia. In patients aged > or =65 years, 1-year and 2-year mortality rates following the occurrence of AF were 38% and 53%, respectively, whereas the rates in those who remained in SR were 14% and 31%, respectively (P=NS). The development of AF was not found to be an independent predictor of mortality. Five patients in the AF group experienced six thromboembolic episodes in a follow-up period of 23.6 (21.4) months (i.e., 15 episodes per 100 patient-years), compared with three episodes per 100 patient-years in the SR group (relative risk=5.2; 95% CI, 2.1-12.4)., Conclusions: Each year, three in every 100 patients in our dialysis unit developed AF. The occurrence of AF increased the risk of a thromboembolic complication five-fold. The use of anticoagulant treatment in these patients should be carefully evaluated.