The effect of hemodialysis on echocardiographic parameters and on supraventricular cardiac arrhythmias

Relevance. Supraventricular arrhythmias are frequent comorbid conditions in patients with end-stage renal failure undergoing dialysis. The prevalence of atrial fibrillation (AF) in this group of patients is higher than in the general population and is associated with increased mortality.

Aim. To analyze the effect of a dialysis session on echocardiographic parameters and to assess their relationship with the occurrence of supraventricular arrhythmias and AF during hemodialysis.

Material and methods. The study included 78 patients on hemodialysis. All patients underwent Holter electrocardiography monitoring, taking into account the heart rate before and after dialysis, the number and duration of AF episodes associated with the dialysis session. Using echocardiography, which was performed before and after the dialysis procedure, all patients were also evaluated for the presence of left ventricular (LV) hypertrophy, impaired systolic and diastolic function, as well as LV myocardial mass, sizes of the left atrium, its volume, volume of the right atrium and LV ejection fraction.

Results. An analysis of the differences in echocardiographic parameters before and after dialysis showed a significantly larger volume of the left atrium, the volume of the right atrium, the width of the inferior vena cava, and the parameter P’(early transmitral velocity) before dialysis compared with the state after dialysis. Also, AF paroxysms were recorded much more frequently after dialysis. The volume of the left atrium >32 mm and the right atrium >30 mm (limit values) were observed much more often in patients before dialysis. A relationship was found between an increased number of paroxysms of atrial fibrillation and a decrease in the volume of the right atrium >5 mm and the left atrium >7 mm after dialysis. No correlation was found between the mass of the LV and the volume of the left atrium.

Conclusions. 1. The age and duration of dialysis therapy in hemodialysis patients are associated with an increased risk of atrial fibrillation. 2. A decrease in the volumes of the right and left atriums after the hemodialysis procedure has a positive correlation with paroxysmal AF. 3. The hemodialysis procedure leads to a decrease in the volumes of the right and left atriums, as well as the width of the inferior vena cava and a decrease in the speed of movement of the mitral valve in early diastole. 4. No relationship was found between the volume of the left atrium and the mass of the LV myocardium in patients on hemodialysis.