Roberts Paul R, Zachariah Donah, Morgan John M, Yue Arthur M, Greenwood Elizabeth F, Phillips Patrick C, Kalra Philip A, Green Darren, Lewis Robert J, Kalra Paul R
Southampton University Hospitals, Southampton, United Kingdom.
Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom.
PLoS One. 2017 Dec 14;12(12):e0188713. doi: 10.1371/journal.pone.0188713. eCollection 2017.
It has been suggested that sudden cardiac death (SCD) contributes around 50% of cardiovascular and 27% of all-cause mortality in hemodialysis patients. The true burden of arrhythmias and arrhythmic deaths in this population, however, remains poorly characterised. Cardio Renal Arrhythmia Study in Hemodialysis (CRASH-ILR) is a prospective, implantable loop recorder single centre study of 30 established hemodialysis patients and one of the first to provide long-term ambulatory ECG monitoring.
30 patients (60% male) aged 68±12 years receiving hemodialysis for 45±40 months with varied etiology (diabetes 37%, hypertension 23%) and left ventricular ejection fraction (LVEF) 55±8% received a Reveal XT implantable loop recorder (Medtronic, USA) between August 2011 and October 2014. ECG data from loop recorders were transmitted at each hemodialysis session using a remote monitoring system. Primary outcome was SCD or implantation of a (tachy or bradyarrhythmia controlling) device and secondary outcome, the development of arrhythmia necessitating medical intervention.
During 379,512 hours of continuous ECG monitoring (mean 12,648±9,024 hours/patient), there were 8 deaths-2 SCD and 6 due to generalised deterioration/sepsis. 5 (20%) patients had a primary outcome event (2 SCD, 3 pacemaker implantations for bradyarrhythmia). 10 (33%) patients reached an arrhythmic primary or secondary end point. Median event free survival for any arrhythmia was 2.6 years (95% confidence intervals 1.6-3.6 years).
The findings confirm the high mortality rate seen in hemodialysis populations and contrary to initial expectations, bradyarrhythmias emerged as a common and potentially significant arrhythmic event.
有人提出，心脏性猝死（SCD）在血液透析患者的心血管死亡中占比约50%，在全因死亡中占比27%。然而，这一人群中心律失常和心律失常性死亡的真实负担仍未得到充分描述。血液透析中的心肺心律失常研究（CRASH-ILR）是一项前瞻性、使用植入式环路记录器的单中心研究，研究对象为30例已确诊的血液透析患者，是首批提供长期动态心电图监测的研究之一。
2011年8月至2014年10月期间，30例年龄68±12岁、接受血液透析45±40个月、病因各异（糖尿病37%，高血压23%）且左心室射血分数（LVEF）为55±8%的患者（60%为男性）植入了Reveal XT植入式环路记录器（美敦力公司，美国）。每次血液透析时，使用远程监测系统传输环路记录器的心电图数据。主要结局为SCD或植入（控制快速或缓慢心律失常的）装置，次要结局为发生需要药物干预的心律失常。
在379,512小时的连续心电图监测期间（平均每位患者12,648±9,024小时），有8例死亡——2例SCD，6例因全身状况恶化/脓毒症死亡。5例（20%）患者发生主要结局事件（2例SCD，3例因缓慢心律失常植入起搏器）。10例（33%）患者达到心律失常的主要或次要终点。任何心律失常的无事件生存中位数为2.6年（95%置信区间1.6 - 3.6年）。
研究结果证实了血液透析人群的高死亡率，与最初的预期相反，缓慢心律失常是一种常见且可能具有重要意义的心律失常事件。
