Timing of Atrial Fibrillation Occurrence in Hemodialysis Patients with Cardiac Implantable Electrical Devices

Abstract

Hemodialysis (HD) patients has the high prevalence of atrial fibrillation (AF), and the procedure of HD itself might be related to risk factors for the onset of AF. On the other hand, cardiac implantable electronic devices (CIEDs), such as pacemaker, implantable cardioverter-defibrillators (ICD) and cardiac resynchronization therapy (CRT) have the function for arrhythmia detection. However, in HD patients with CIEDs, there are no studies that observe AF over long periods of time. The aim of this study is to investigate AF onset and duration of HD patients with AF, using the AF detection and memory function of CIEDs. Consecutive HD patients who were newly implanted with CIEDs between January 2008 and December 2021 were retrospectively analyzed in this study. Patients with chronic AF, with leadless pacemaker and without post-implantation follow-up were excluded from this study. Subclinical AF was defined from previous studies as atrial tachyarrhythmia lasting more than 6 minutes in memories of devices. The primary endpoint of this study was the subclinical AF within one year after CIESDs implantation. HD week was defined as follows according to HD schedule, HD1: Monday or Tuesday; HD1+1: Tuesday or Wednesday; HD2 Wednesday or Thursday; HD2+1 Thursday or Friday; HD3 Friday or Saturday; HD3+1 as Saturday or Sunday; and HD3+2 Sunday or Monday. We examined the association between onset and duration of AF and HD. Fifty-four HD patients who had been implanted with CIEDs (pacemaker: 37, ICD: 6, CRT: 11) were enrolled in the study. During a mean follow-up period of 352 ± 36 days, in 26 of 54 (48.1%) patients, 124 subclinical AF events (1-8 events / patient) were detected with CIEDs. History of clinical AF (46.2% vs 7.1%, p = 0.003) and sick sinus syndrome (53.8% vs 10.7%, p = 0.005) were significantly higher in HD patients with than without subclinical AF. The frequency of subclinical AF onset on HD day was approximately twice higher than on non-HD day (83 episodes [27.7 episodes/day] vs 41 episodes [10.3 episodes/day]), and subclinical AF onset on HD1 day was most frequent among a week (Figure 1a). Limited to HD day, subclinical AF events were observed more frequently especially during HD (30/86 events: 34.9%) and five hours after HD (28/86 events: 32.6%) (Fig. 1-b). Subclinical AF duration was significantly longer during HD compared to non-HD time (216 [90, 1066] min vs 96 [30, 418] min, p = 0.008). In HD patients, subclinical AF occurred more frequently on HD day, especially during HD and several hours after HD. Careful observation during and after HD might help early diagnosis of clinical AF.