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Electrocardiographic changes during haemodialysis and the potential impact on subcutaneous implantable cardioverter defibrillator eligibility

Haemodialysis patients who require defibrillator therapy are expected to benefit from the entirely avascular subcutaneous defibrillator (S-ICD), but haemodialysis is associated with dynamic changes in R and T wave amplitude which can impact S-ICD eligibility. A continuous assessment of S-ICD eligibi... Full description

Journal Title: Journal of electrocardiology 2022, Vol.72, p.21-27
Main Author: Wiles, Benedict M.
Other Authors: Morgan, John M. , Kirk, Adam , Allavatam, Venugopal , ElRefai, Mohamed , Roberts, Paul R.
Format: Electronic Article Electronic Article
Language: English
Subjects:
Quelle: Alma/SFX Local Collection
Publisher: United States: Elsevier Inc
ID: ISSN: 0022-0736
Link: https://www.ncbi.nlm.nih.gov/pubmed/35247804
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recordid: cdi_proquest_miscellaneous_2636140673
title: Electrocardiographic changes during haemodialysis and the potential impact on subcutaneous implantable cardioverter defibrillator eligibility
format: Article
creator:
  • Wiles, Benedict M.
  • Morgan, John M.
  • Kirk, Adam
  • Allavatam, Venugopal
  • ElRefai, Mohamed
  • Roberts, Paul R.
subjects:
  • Defibrillator
  • Defibrillators
  • Electrocardiography
  • Haemodialysis
  • Hemodialysis
  • Implants, Artificial
  • Medical screening
  • Medical treatment
  • Prosthesis
  • S-ICD
  • Subcutaneous
  • Vector
ispartof: Journal of electrocardiology, 2022, Vol.72, p.21-27
description: Haemodialysis patients who require defibrillator therapy are expected to benefit from the entirely avascular subcutaneous defibrillator (S-ICD), but haemodialysis is associated with dynamic changes in R and T wave amplitude which can impact S-ICD eligibility. A continuous assessment of S-ICD eligibility during haemodialysis has not previously been performed. Continuous surface ECG recordings were obtained from a cohort of patients undergoing maintenance haemodialysis, but without an indication for an ICD. Automated vector screening was retrospectively performed at one-minute intervals throughout the dialysis session. Variations in S-ICD eligibility were calculated and in vectors with high degrees of variation, the underlying mechanism was identified. 72 vector recordings (mean duration 254.1 ± 6.0 min) were obtained from 24 patients (mean age 64.3 ± 5.5 years, 68% male). At the start of haemodialysis 47 vectors were S-ICD eligible (65.2%). At the end of session, all of these vectors had remained eligible, and an additional 6 vectors had also become eligible (73.6%). High vector score variability was observed in 7 patients and the commonest cause was a progressive change in R:T ratio (71.5%). In a haemodialysis population, a single haemodialysis session can be associated with a potential change in S-ICD eligibility in 8.4% of vectors, with up to 12.5% of vectors showing high degrees of variability, most commonly due to variations in R:T ratio. In an S-ICD population with similar characteristics S-ICD screening prior to haemodialysis would be expected to more accurately identify vectors that retain eligibility. •S-ICD eligibility is dynamic.•Variations in S-ICD eligibility occur during a single haemodialysis session.•Small changes in R and T wave amplitude can result in vector ineligibility.•Vectors that are vulnerable to dynamic change are more accurately identified immediately prior to dialysis.
language: eng
source: Alma/SFX Local Collection
identifier: ISSN: 0022-0736
fulltext: fulltext
issn:
  • 0022-0736
  • 1532-8430
url: Link


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descriptionHaemodialysis patients who require defibrillator therapy are expected to benefit from the entirely avascular subcutaneous defibrillator (S-ICD), but haemodialysis is associated with dynamic changes in R and T wave amplitude which can impact S-ICD eligibility. A continuous assessment of S-ICD eligibility during haemodialysis has not previously been performed. Continuous surface ECG recordings were obtained from a cohort of patients undergoing maintenance haemodialysis, but without an indication for an ICD. Automated vector screening was retrospectively performed at one-minute intervals throughout the dialysis session. Variations in S-ICD eligibility were calculated and in vectors with high degrees of variation, the underlying mechanism was identified. 72 vector recordings (mean duration 254.1 ± 6.0 min) were obtained from 24 patients (mean age 64.3 ± 5.5 years, 68% male). At the start of haemodialysis 47 vectors were S-ICD eligible (65.2%). At the end of session, all of these vectors had remained eligible, and an additional 6 vectors had also become eligible (73.6%). High vector score variability was observed in 7 patients and the commonest cause was a progressive change in R:T ratio (71.5%). In a haemodialysis population, a single haemodialysis session can be associated with a potential change in S-ICD eligibility in 8.4% of vectors, with up to 12.5% of vectors showing high degrees of variability, most commonly due to variations in R:T ratio. In an S-ICD population with similar characteristics S-ICD screening prior to haemodialysis would be expected to more accurately identify vectors that retain eligibility. •S-ICD eligibility is dynamic.•Variations in S-ICD eligibility occur during a single haemodialysis session.•Small changes in R and T wave amplitude can result in vector ineligibility.•Vectors that are vulnerable to dynamic change are more accurately identified immediately prior to dialysis.
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subjectDefibrillator ; Defibrillators ; Electrocardiography ; Haemodialysis ; Hemodialysis ; Implants, Artificial ; Medical screening ; Medical treatment ; Prosthesis ; S-ICD ; Subcutaneous ; Vector
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descriptionHaemodialysis patients who require defibrillator therapy are expected to benefit from the entirely avascular subcutaneous defibrillator (S-ICD), but haemodialysis is associated with dynamic changes in R and T wave amplitude which can impact S-ICD eligibility. A continuous assessment of S-ICD eligibility during haemodialysis has not previously been performed. Continuous surface ECG recordings were obtained from a cohort of patients undergoing maintenance haemodialysis, but without an indication for an ICD. Automated vector screening was retrospectively performed at one-minute intervals throughout the dialysis session. Variations in S-ICD eligibility were calculated and in vectors with high degrees of variation, the underlying mechanism was identified. 72 vector recordings (mean duration 254.1 ± 6.0 min) were obtained from 24 patients (mean age 64.3 ± 5.5 years, 68% male). At the start of haemodialysis 47 vectors were S-ICD eligible (65.2%). At the end of session, all of these vectors had remained eligible, and an additional 6 vectors had also become eligible (73.6%). High vector score variability was observed in 7 patients and the commonest cause was a progressive change in R:T ratio (71.5%). In a haemodialysis population, a single haemodialysis session can be associated with a potential change in S-ICD eligibility in 8.4% of vectors, with up to 12.5% of vectors showing high degrees of variability, most commonly due to variations in R:T ratio. In an S-ICD population with similar characteristics S-ICD screening prior to haemodialysis would be expected to more accurately identify vectors that retain eligibility. •S-ICD eligibility is dynamic.•Variations in S-ICD eligibility occur during a single haemodialysis session.•Small changes in R and T wave amplitude can result in vector ineligibility.•Vectors that are vulnerable to dynamic change are more accurately identified immediately prior to dialysis.
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abstractHaemodialysis patients who require defibrillator therapy are expected to benefit from the entirely avascular subcutaneous defibrillator (S-ICD), but haemodialysis is associated with dynamic changes in R and T wave amplitude which can impact S-ICD eligibility. A continuous assessment of S-ICD eligibility during haemodialysis has not previously been performed. Continuous surface ECG recordings were obtained from a cohort of patients undergoing maintenance haemodialysis, but without an indication for an ICD. Automated vector screening was retrospectively performed at one-minute intervals throughout the dialysis session. Variations in S-ICD eligibility were calculated and in vectors with high degrees of variation, the underlying mechanism was identified. 72 vector recordings (mean duration 254.1 ± 6.0 min) were obtained from 24 patients (mean age 64.3 ± 5.5 years, 68% male). At the start of haemodialysis 47 vectors were S-ICD eligible (65.2%). At the end of session, all of these vectors had remained eligible, and an additional 6 vectors had also become eligible (73.6%). High vector score variability was observed in 7 patients and the commonest cause was a progressive change in R:T ratio (71.5%). In a haemodialysis population, a single haemodialysis session can be associated with a potential change in S-ICD eligibility in 8.4% of vectors, with up to 12.5% of vectors showing high degrees of variability, most commonly due to variations in R:T ratio. In an S-ICD population with similar characteristics S-ICD screening prior to haemodialysis would be expected to more accurately identify vectors that retain eligibility. •S-ICD eligibility is dynamic.•Variations in S-ICD eligibility occur during a single haemodialysis session.•Small changes in R and T wave amplitude can result in vector ineligibility.•Vectors that are vulnerable to dynamic change are more accurately identified immediately prior to dialysis.
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pmid35247804
doi10.1016/j.jelectrocard.2022.02.008
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