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 dispersion^1,2.

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

Prevention

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

References:

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