Cardiac Arrhythmias

Risk Factors

  • Left ventricular hypertrophy
  • Heart failure
  • Ischemic heart disease
  • Other factors
    • Age
    • Respiratory failure
    • Rapid reduction of extra-cellular volume
    • Electrolyte and acid-base derangement
    • Cardiac and major vascular surgery
    • Digoxin therapy
    • Sympathetic dysfunction
    • Increased phosphate and PTH
  • High risk in those with reduced heart rate variability and increased QT dispersion1,2.

Diagnosis and Treatment

  • Draw blood samples for electrolytes, bicarbonate and glucose levels
  • EKG, oxygen, IV fluids
  • May need to discontinue HD. Correct electrolyte disturbance (especially potassium, calcium and magnesium)
  • Cardioversion with AED (automated external defibrillator) in case patient is hemodynamically unstable and has a treatable rhythm
  • Digoxin can be used to control ventricular rate in SVT.
    • Patients on digitalis might need increase of the dialysate potassium to 3- 3.5 mEq/L to prevent hypokalemia3.
  • Amiodarone can be used in usual dose for ventricular arrhythmias
  • Intracellular shift of potassium can be minimized by reducing dialysate glucose (from 200 to 100 mg/dl), and when acid base status permits, bicarbonate level1


  • Avoidance of low hemoglobin levels and hypoxia during dialysis. Maintenance of optimal calcium, phosphate and PTH levels
  • Oxygen use


  1. Erem C, Kulan K, Tuncer C, Bostan M, Mocan Z, Komsuoglu B. Cardiac arrhythmias in patients on maintenance hemodialysis. Acta Cardiol 52:25-36, 1997
  2. Kantarchi G, Ozener C, Tokay S, Bihorac A, Akoglu E. QT Dispersion in Hemodialysis and CAPD Patients. Nephron 91:739-741, 2002
  3. Anthony J Nicholls: Heart and Circulation in Daugirdas JT, Blake PG, Todd SI. Handbook of Hemodialysis. Third Edition. Lippincott Williams & Wilikns. Philadelphia 2:594-596, 2001