Division of Cardiology, Peter Munk Cardiac Center, Toronto General Hospital, Toronto, Ontario, Canada.
Division of Nephrology, Toronto General Hospital, Toronto, Ontario, Canada.
Can J Cardiol. 2019 Sep;35(9):1228-1240. doi: 10.1016/j.cjca.2019.05.005. Epub 2019 May 15.
Patients with end-stage renal disease (ESRD) are predisposed to heart rhythm disorders resulting in significant morbidity and mortality. Bradyarrhythmia appears to be more prevalent than ventricular tachyarrhythmias. There is also a high incidence of sudden cardiac death (SCD) in this group of patients, which cannot be explained only by traditional cardiac risk factors. The reported incidence and prevalence of arrhythmias and SCD is quite variable mainly because of the different study populations and recording techniques. The mechanism of SCD in patients with ESRD is also not clear. Although traditionally the thinking has been that ventricular arrhythmias are the main contributor to SCD, recent studies with implantable loop recorders have highlighted the role of bradyarrhythmias. The pathophysiological processes resulting in arrhythmia and SCD in patients with ESRD are unique. Some of the risk factors, including dialysate composition, timing, and frequency, are modifiable and hence provide an option for interventions to potentially reduce SCD. In addition, there might be a relationship with the timing of dialysis with SCD tending to occur during the long interdialytic period. Patients with ESRD have a higher likelihood of requiring pacemaker implantation; however, they also have a higher risk of device-related complications. The limited data available regarding the role of the implantable cardioverter defibrillator to prevent SCD in patients with ESRD have shown conflicting results. Future research is needed to develop appropriate risk stratification tools to identify patients who will benefit from such interventions and to assess their safety and efficacy.
终末期肾病 (ESRD) 患者易发生心律失常，导致发病率和死亡率显著增加。缓慢性心律失常似乎比室性快速性心律失常更为常见。这组患者也有很高的心脏性猝死 (SCD) 发生率，仅用传统的心脏危险因素无法解释。心律失常和 SCD 的报告发生率和患病率差异很大，主要是因为不同的研究人群和记录技术。ESRD 患者 SCD 的机制也不清楚。尽管传统上认为室性心律失常是 SCD 的主要原因，但最近使用植入式环路记录器的研究强调了缓慢性心律失常的作用。导致 ESRD 患者心律失常和 SCD 的病理生理过程是独特的。一些风险因素，包括透析液成分、时间和频率，是可以改变的，因此为潜在减少 SCD 的干预措施提供了选择。此外，可能与透析时间有关，SCD 往往发生在长透析间期。ESRD 患者更有可能需要植入起搏器；然而，他们也有更高的器械相关并发症风险。关于植入式心脏复律除颤器在预防 ESRD 患者 SCD 中的作用的有限数据显示出相互矛盾的结果。需要进一步研究以开发适当的风险分层工具，以确定哪些患者将从这些干预措施中受益，并评估其安全性和疗效。
