与血液透析疗程相关的心房电生理改变：来自多尺度计算机模型的见解
Alterations of atrial electrophysiology related to hemodialysis session: insights from a multiscale computer model.
作者信息
Krueger Martin Wolfgang, Severi Stefano, Rhode Kawal, Genovesi Simonetta, Weber Frank Michael, Vincenti Antonio, Fabbrini Paolo, Seemann Gunnar, Razavi Reza, Dössel Olaf
机构信息
Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany.
出版信息
J Electrocardiol. 2011 Mar-Apr;44(2):176-83. doi: 10.1016/j.jelectrocard.2010.11.016.
BACKGROUND
The prevalence of atrial fibrillation is increased in patients with end-stage renal disease. Previous studies suggested that extracellular electrolyte alterations caused by hemodialysis (HD) therapy could be proarrhythmic.
METHODS
Multiscale models were used for a consequent analysis of the effects of extracellular ion concentration changes on atrial electrophysiology. Simulations were based on measured electrolyte concentrations from patients with end-stage renal disease.
RESULTS
Simulated conduction velocity and effective refractory period are decreased at the end of an HD session, with potassium having the strongest influence. P-wave is prolonged in patients undergoing HD therapy in the simulation as in measurements.
CONCLUSIONS
Electrolyte concentration alterations impact atrial electrophysiology from the action potential level to the P-wave and can be proarrhythmic, especially because of induced hypokalemia. Analysis of blood electrolytes enables patient-specific electrophysiology modeling. We are providing a tool to investigate atrial arrhythmias associated with HD therapy, which, in the future, can be used to prevent such complications.
背景
终末期肾病患者心房颤动的患病率增加。先前的研究表明，血液透析（HD）治疗引起的细胞外电解质改变可能会促发心律失常。
方法
使用多尺度模型对细胞外离子浓度变化对心房电生理的影响进行后续分析。模拟基于终末期肾病患者测得的电解质浓度。
结果
HD治疗结束时，模拟的传导速度和有效不应期降低，其中钾的影响最强。模拟中接受HD治疗的患者的P波与测量结果一样延长。
结论
电解质浓度改变会影响从动作电位水平到P波的心房电生理，并且可能促发心律失常，尤其是由于诱发的低钾血症。血液电解质分析可实现针对患者的电生理建模。我们正在提供一种工具来研究与HD治疗相关的房性心律失常，未来可用于预防此类并发症。
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