Páll Alida, Czifra Árpád, Sebestyén Veronika, Becs Gergely, Kun Csaba, Balla József, Paragh György, Lőrincz István, Páll Dénes, Padra Tamás János, Agarwal Anupam, Zarjou Abolfazl, Szabó Zoltán
Division of Emergency Medicine, Faculty of Medicine, Clinical Center, Institute of Medicine, University of Debrecen, Nagyerdei krt. 98, P.O. Box 19, 4032, Debrecen, Hungary.
Division of Nephrology, Faculty of Medicine, Clinical Center, Institute of Medicine, University of Debrecen, Debrecen, Hungary.
Int Urol Nephrol. 2016 Feb;48(2):271-7. doi: 10.1007/s11255-015-1144-4. Epub 2015 Nov 11.
The incidence of atrial fibrillation is increased during hemodialysis (HD); however, the effects of hemodiafiltration (HDF) on atrial arrhythmias have not been evaluated. The prolongation of the P wave and P dispersion (Pd) can predict atrial arrhythmias.
Data from 30 patients receiving HDF over a period of 3 months were collected; the same group of patients was then evaluated during treatment with conventional HD for at least another 3 months. Electrolyte values were obtained, and surface electrocardiograms (ECG), echocardiography, and Holter ECGs were performed.
The duration of the P wave and Pd increased significantly during HD. The left atrial diameter decreased significantly only during HDF. During HDF, the left atrial cross diameter measured at the beginning of the session was positively correlated with the incidence of supraventricular premature beats (p = 0.011, r = 0.4556). The decrease in left atrial diameter during HDF was negatively correlated with the incidence of supraventricular premature beats (p = 0.016, r = -0.43). During HDF, the changes in sodium and Pd were significantly positively correlated (p < 0.05, r = 0.478). During HD, the changes in ionized calcium levels and Pd were positively correlated (p < 0.05, r = 0.377).
Our results suggest that HDF has a more beneficial effect on P wave duration and Pd than HD. The alterations in the ECG markers may be the result of the simultaneous occurrence of certain electrolyte imbalances and renal replacement methods.
血液透析（HD）期间心房颤动的发生率会增加；然而，血液透析滤过（HDF）对房性心律失常的影响尚未得到评估。P波延长和P波离散度（Pd）可预测房性心律失常。
收集30例接受HDF治疗3个月患者的数据；然后对同一组患者在接受传统HD治疗至少另外3个月期间进行评估。获取电解质值，并进行体表心电图（ECG）、超声心动图和动态心电图检查。
HD期间P波时限和Pd显著增加。仅在HDF期间左心房直径显著减小。在HDF期间，治疗开始时测量的左心房横径与室上性早搏发生率呈正相关（p = 0.011，r = 0.4556）。HDF期间左心房直径减小与室上性早搏发生率呈负相关（p = 0.016，r = -0.43）。在HDF期间，钠和Pd的变化显著正相关（p < 0.05，r = 0.478）。在HD期间，离子钙水平变化与Pd呈正相关（p < 0.05，r = 0.377）。
我们的结果表明，与HD相比，HDF对P波时限和Pd有更有益的影响。心电图标志物的改变可能是某些电解质失衡与肾脏替代方法同时出现的结果。
