Evaluation of the impact of asymptomatic supraventricular arrhythmias on the incidence of serious adverse events in patients on chronic hemodialysis

Abstract

Objective: To assess the relationship of arrhythmic events such as supraventricular arrhythmias and asymptomatic arrhythmias and their long-term association with adverse events among patients undergoing chronic hemodialysis.Materials and methods: a study was conducted involving 87 patients undergoing chronic hemodialysis with a 10-year follow-up period. At the inclusion stage, sinus rhythm was registered in all patients. A total of 87 patients (47 men and 40 women; mean age 56.3±16.1 years) took part. All patients underwent Holter monitoring (HM) of the ECG after each hemodialysis procedure, 6 times in a row, and the indicators obtained during the echocardiographic study were also evaluated.Results: after evaluating the results obtained and statistically processing the data, it was found that 71.2% of patients had arterial hypertension, 30.6% had type 2 diabetes mellitus. During HM, supraventricular arrhythmias were detected in 43 patients (49.4%); these arrhythmias were short-term, asymptomatic and stopped on their own. Age (hazard ratio [HR], 1.07 per year; 95% confidence interval [95% CI], 1.02 to 1.09) and right atrial enlargement (hazard ratio [HR] 4.31; 95 % CI 1.33 to 14.12), which showed a direct association with supraventricular arrhythmia in multivariate analysis. During 48 months, 67 patients died, the main cause of death of which was cardiovascular disease (58.4%). In the Cox model, the variables associated with all-cause mortality were C-reactive protein (RR, 1.03 per 1 mg/l; 95% confidence interval from 1.00 to 1.08), age (RR, 1.07 per year; 95% CI, 1.00 to 1.08), supraventricular arrhythmias (RR 3.42; 95% CI, 1.34 to 7.91). Patients with supraventricular arrhythmia had a significantly higher risk of non-fatal cardiovascular events (hazard ratio, 4.41; 95% confidence interval, 2.18–8.89).Conclusion: a direct relationship has been demonstrated between the presence of supraventricular arrhythmias during chronic hemodialysis and symptomatic AF, which will develop in these patients in the future. The main aggravating factors associated with mortality in patients on dialysis were supraventricular arrhythmias, advanced age, and elevated C-reactive protein.