1
|
Masmoudi I, Dindane Z, Richter S, Ebert M. Ventricular arrhythmias in the context of chronic kidney disease and electrolyte imbalance. Herzschrittmacherther Elektrophysiol 2024:10.1007/s00399-024-01029-7. [PMID: 39008102 DOI: 10.1007/s00399-024-01029-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2024] [Indexed: 07/16/2024]
Abstract
Patients with chronic kidney disease face a high risk of sudden cardiac death, particularly in more advanced stages of renal dysfunction. Ventricular arrhythmias are prevalent and contribute to the heightened cardiovascular mortality. This review aims to explore the intricate interplay of disease-specific risk factors, arrhythmic triggers, and electrolyte disorders that amplify susceptibility to ventricular arrhythmias and sudden cardiac death in this population and influence the efficacy of available treatments.
Collapse
Affiliation(s)
- Ines Masmoudi
- Division of Electrophysiology, Department for Internal Medicine and Cardiology, Heart Centre Dresden, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Dresden, Germany
| | - Zouhir Dindane
- Division of Electrophysiology, Department for Internal Medicine and Cardiology, Heart Centre Dresden, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Dresden, Germany
| | - Sergio Richter
- Division of Electrophysiology, Department for Internal Medicine and Cardiology, Heart Centre Dresden, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Dresden, Germany
| | - Micaela Ebert
- Division of Electrophysiology, Department for Internal Medicine and Cardiology, Heart Centre Dresden, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Dresden, Germany.
- Sektion Rhythmologie, Klinik für Innere Medizin und Kardiologie, Herzzentrum Dresden, Medizinische Fakultät und Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 76, 01307, Dresden, Germany.
| |
Collapse
|
2
|
Caba B, Vasiliu L, Covic MA, Sascau R, Statescu C, Covic A. Cardiac Device Therapy in Patients with Chronic Kidney Disease: An Update. J Clin Med 2024; 13:516. [PMID: 38256650 PMCID: PMC10816721 DOI: 10.3390/jcm13020516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 01/13/2024] [Accepted: 01/15/2024] [Indexed: 01/24/2024] Open
Abstract
Cardiovascular diseases (CVDs) and chronic kidney disease (CKD) are frequently interconnected and their association leads to an exponential increase in the risk of both fatal and non-fatal events. In addition, the burden of arrhythmias in CKD patients is increased. On the other hand, the presence of CKD is an important factor that influences the decision to pursue cardiac device therapy. Data on CKD patients with device therapy are scarce and mostly derives from observational studies and case reports. Cardiac resynchronization therapy (CRT) is associated with decreased mortality, reduced heart failure symptoms, and improved renal function in early stages of CKD. Implantable cardioverter defibrillators (ICDs) are associated with a significant reduction in the mortality of CKD patients only for the secondary prevention of sudden cardiac death. Cardiac resynchronization therapy with defibrillator (CRT-D) is preferred in patients who meet the established criteria. The need for cardiac pacing is increased three-fold in dialysis patients. CKD is an independent risk factor for infections associated with cardiac devices.
Collapse
Affiliation(s)
- Bogdan Caba
- Faculty of Medicine, “Grigore T. Popa” University of Medicine, 700115 Iasi, Romania; (B.C.); (L.V.); (R.S.); (C.S.); (A.C.)
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I. M. Georgescu”, 700503 Iasi, Romania
| | - Laura Vasiliu
- Faculty of Medicine, “Grigore T. Popa” University of Medicine, 700115 Iasi, Romania; (B.C.); (L.V.); (R.S.); (C.S.); (A.C.)
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I. M. Georgescu”, 700503 Iasi, Romania
| | - Maria Alexandra Covic
- Faculty of Medicine, “Grigore T. Popa” University of Medicine, 700115 Iasi, Romania; (B.C.); (L.V.); (R.S.); (C.S.); (A.C.)
| | - Radu Sascau
- Faculty of Medicine, “Grigore T. Popa” University of Medicine, 700115 Iasi, Romania; (B.C.); (L.V.); (R.S.); (C.S.); (A.C.)
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I. M. Georgescu”, 700503 Iasi, Romania
| | - Cristian Statescu
- Faculty of Medicine, “Grigore T. Popa” University of Medicine, 700115 Iasi, Romania; (B.C.); (L.V.); (R.S.); (C.S.); (A.C.)
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I. M. Georgescu”, 700503 Iasi, Romania
| | - Adrian Covic
- Faculty of Medicine, “Grigore T. Popa” University of Medicine, 700115 Iasi, Romania; (B.C.); (L.V.); (R.S.); (C.S.); (A.C.)
- Nephrology Department, Dialysis and Renal Transplant Center, “Dr. C.I. Parhon” University Hospital, 700503 Iasi, Romania
| |
Collapse
|
3
|
Goldenberg I, Kutyifa V, Zareba W, Huang DTC, Rosero SZ, Younis A, Schuger C, Gao A, McNitt S, Polonsky B, Steinberg JS, Goldenberg I, Aktas MK. Primary prevention implantable cardioverter defibrillator in cardiac resynchronization therapy recipients with advanced chronic kidney disease. Front Cardiovasc Med 2023; 10:1237118. [PMID: 37680559 PMCID: PMC10482044 DOI: 10.3389/fcvm.2023.1237118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/18/2023] [Indexed: 09/09/2023] Open
Abstract
Introduction The implantable cardioverter defibrillator (ICD) is effective for the prevention of sudden cardiac death (SCD) in patients with heart failure and a reduced ejection fraction (HFrEF). The benefit of the ICD in patients with advanced CKD, remains elusive. Moreover, the benefit of the ICD in patients with advanced chronic kidney disease (CKD) and HFrEF who are cardiac resynchronization therapy (CRT) recipients may be attenuated. Hypothesis We hypothesized that patients with CKD who are CRT recipients may derive less benefit from the ICD due to the competing risk of dying prior to experiencing an arrhythmia. Methods The study population included 1,015 patients receiving CRT with defibrillator (CRT-D) device for primary prevention of SCD who were enrolled in either (Multicenter Automated Defibrillator Implantation Trial) MADIT-CRT trial or the Ranolazine in High-Risk Patients with Implanted Cardioverter Defibrillator (RAID) trial. The cohort was divided into two groups based on the stage of CKD: those with Stage 1 to 3a KD, labeled as (S1-S3a)KD. The second group included patients with Stage 3b to stage 5 kidney disease, labeled as (S3b-S5)KD. The primary endpoint was any ventricular tachycardia (VT) or ventricular fibrillation (VF) (Any VT/VF). Results The cumulative incidence of Any VT/VF was 23.5% in patients with (S1-S3a)KD and 12.6% in those with (S3b-S5)KD (p < 0.001) The incidence of Death without Any VT/VF was 6.6% in patients with (S1-S3a)KD and 21.6% in patients with (S3b-S5)KD (p < 0.001). A Fine and Gray multivariate competing risk regression model showed that Patients with (S3b-S5)KD had a 43% less risk of experiencing Any VT/VF when compared to those with (S1-S3a)KD (HR = 0.56, 95% CI [0.33-0.94] p = 0.03. After two years of follow up, there was almost a 5-fold increased risk of Death without Any VT/VF among patients with (S3b-S5)KD when compared to those with (S1-S3a)KD [HR = 4.63, 95% CI (2.46-8.72), p for interaction with time = 0.012]. Conclusion Due to their lower incidence of arrhythmias and higher risk of dying prior to experiencing an arrhythmia, the benefit of the ICD may be attenuated in CRT recipients with advanced CKD. Future prospective trials should evaluate whether CRT without a defibrillator may be more appropriate for these patients.
Collapse
Affiliation(s)
- Ido Goldenberg
- University of Rochester Medical Center, Rochester, NY, United States
- Rochester General Hospital, Rochester, NY, United States
| | - Valentina Kutyifa
- University of Rochester Medical Center, Rochester, NY, United States
| | - Wojciech Zareba
- University of Rochester Medical Center, Rochester, NY, United States
| | | | - Spencer Z. Rosero
- University of Rochester Medical Center, Rochester, NY, United States
| | - Arwa Younis
- University of Rochester Medical Center, Rochester, NY, United States
| | - Claudio Schuger
- University of Rochester Medical Center, Rochester, NY, United States
| | - Anna Gao
- University of Rochester Medical Center, Rochester, NY, United States
| | - Scott McNitt
- University of Rochester Medical Center, Rochester, NY, United States
| | | | | | - Ilan Goldenberg
- University of Rochester Medical Center, Rochester, NY, United States
| | - Mehmet K. Aktas
- University of Rochester Medical Center, Rochester, NY, United States
| |
Collapse
|
4
|
Effect of Implanted Defibrillator on Mortality in Patients With Chronic Kidney Disease. Am J Cardiol 2023; 188:36-40. [PMID: 36463780 DOI: 10.1016/j.amjcard.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 10/06/2022] [Accepted: 11/04/2022] [Indexed: 12/04/2022]
Abstract
The beneficial role of implantable cardioverter defibrillators (ICDs) in patients with chronic kidney disease (CKD) is controversial. This meta-analysis aimed to evaluate the effect of ICD on mortality in patients with CKD. A literature search was conducted for studies reporting the effect of ICD on all-cause mortality in patients with CKD (estimated glomerular filtration rate <60 ml/min/1.73 m2). The search was not restricted to time or publication status. The search included the following databases: Ovid MEDLINE, EMBASE, Scopus, Web of Science, Google Scholar, and EBSCO CINAHL. The primary end point was all-cause mortality. The minimum duration of follow-up required for inclusion was 1 year. The literature search identified 834 studies, of which 14 studies with 70,661 patients were included. Mean follow-up was 39 months (12 to 81 months). For all patients with CKD, ICD was associated with lower all-cause mortality (log hazard ratio [HR] -0.247, standard error [SE] 0.101, p = 0.015). Heterogeneity: degree of freedom = 13 (p <0.01), I2 = 97.057; test for overall effect: Z = -2.431 (p = 0.015). When further stratified based on dialysis, patients with CKD without the need for dialysis had significantly lower mortality (log HR -0.211, SE 0.095, p = 0.026), with a similar trend in patients who underwent dialysis (log HR -0.262, SE 0.134, p = 0.051). ICD implantation is associated with a significant mortality benefit in patients with CKD.
Collapse
|
5
|
Ryan DK, Banerjee D, Jouhra F. Management of Heart Failure in Patients with Chronic Kidney Disease. Eur Cardiol 2022; 17:e17. [PMID: 35990402 PMCID: PMC9376857 DOI: 10.15420/ecr.2021.33] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 04/11/2022] [Indexed: 11/19/2022] Open
Abstract
Chronic kidney disease (CKD) is increasingly prevalent in patients with heart failure (HF) and HF is one of the leading causes of hospitalisation, morbidity and mortality in patients with impaired renal function. Currently, there is strong evidence to support the symptomatic and prognostic benefits of β-blockers, renin–angiotensin–aldosterone inhibitors (RAASis), angiotensin receptor-neprilysin inhibitors (ARNIs) and mineralocorticoid receptor antagonists (MRA) in patients with HF and CKD stages 1–3. However, ARNIs, RAASis and MRAs are often suboptimally prescribed for patients with CKD owing to concerns about hyperkalaemia and worsening renal function. There is growing evidence for the use of sodium–glucose co-transporter 2 inhibitors and IV iron therapy in the management of HF in patients with CKD. However, few studies have included patients with CKD stages 4–5 and patients receiving dialysis, limiting the assessment of the safety and efficacy of these therapies in advanced CKD. Interdisciplinary input from HF and renal specialists is required to provide integrated care for the growing number of patients with HF and CKD.
Collapse
Affiliation(s)
- David K Ryan
- Clinical Pharmacology and Therapeutics, University College London Hospitals NHS Foundation Trust, London, UK
| | - Debasish Banerjee
- Renal and Transplantation Unit, St George’s University Hospitals NHS Foundation Trust, and Transactional and Clinical Research Institute, London, UK; Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George’s University of London, London, UK
| | - Fadi Jouhra
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George’s University of London, London, UK; Cardiology Department, St George’s University Hospitals NHS Foundation Trust, London, UK
| |
Collapse
|
6
|
Cardiac Implantable Electronic Devices in Hemodialysis and Chronic Kidney Disease Patients-An Experience-Based Narrative Review. J Clin Med 2021; 10:jcm10081745. [PMID: 33920553 PMCID: PMC8073061 DOI: 10.3390/jcm10081745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/03/2021] [Accepted: 04/13/2021] [Indexed: 11/17/2022] Open
Abstract
Cardiovascular implantable electronic devices (CIEDs) are a standard therapy utilized for different cardiac conditions. They are implanted in a growing number of patients, including those with chronic kidney disease (CKD) and end-stage kidney disease (ESKD). Cardiovascular diseases, including heart failure and malignant arrhythmia, remain the leading cause of mortality among CKD patients, especially in ESKD. CIED implantation procedures are considered minor surgery, typically with transvenous leads inserted via upper central veins, followed by an impulse generator introduced subcutaneously. A decision regarding optimal hemodialysis (HD) modality and the choice of permanent vascular access (VA) could be particularly challenging in CIED recipients. The potential consequences of arteriovenous access on the CIED side are related to (1) venous hypertension from lead-related central vein stenosis and (2) the risk of systemic infection. Therefore, when creating permanent vascular access, the clinical scenario may be complicated by the CIED presence on one side and the lack of suitable vessels for arteriovenous fistula on the contralateral arm. These factors suggest the need for an individualized approach according to different clinical situations: (1) CIED in a CKD patient; (2) CIED in a patient on hemodialysis CIED; and (3) VA in a patient with CIED. This complex clinical conundrum creates the necessity for close cooperation between cardiologists and nephrologists.
Collapse
|
7
|
Bogossian H, Panteloglou D, Karosiene Z, Macher-Heidrich S, Adomeit HJ, Lemke B, Israel CW. [Perioprocedural mortality after ICD implantation]. Herz 2021; 46:581-588. [PMID: 33860805 PMCID: PMC8642318 DOI: 10.1007/s00059-021-05033-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 03/02/2021] [Accepted: 03/16/2021] [Indexed: 01/21/2023]
Abstract
Hintergrund Implantierbare Kardioverter-Defibrillatoren (ICD) sind zum Schutz vor plötzlichem Herztod bei Patienten mit primär- oder sekundärprophylaktischer Indikation etabliert. Wie bei allen komplexen operativen Verfahren verbleibt auch bei der ICD-Implantation ein Risiko für Komplikationen bis hin zum Tod. Gegenstand der vorliegenden Arbeit ist es, anhand der Datensätze zur obligaten Qualitätssicherung in Nordrhein-Westfalen die prozedurbezogene Mortalität nach ICD-Implantation zu analysieren. Methoden Aus den Datensätzen erfolgte eine Analyse der stationären Todesfälle bei allen 18.625 ICD-Implantationen der Jahre 2010 bis 2012. Ergebnisse Während des stationären Aufenthalts verstarben 118 Patienten (0,6 %) nach ICD-Implantation. Patienten im Alter über 80 Jahre (7 %) zeigten eine höhere Mortalität (1,9 % vs. 0,5 % bei < 80-jährigen Patienten, p > 0,001), ebenso Frauen (0,95 % vs. 0,54 % bei Männern; p = 0,004) und Patienten mit hoher NYHA(New York Heart Association)-Klasse (0,3 % bei NYHA II, 0,7 % bei NYHA III, 3,4 % bei NYHA IV; p < 0,001 für alle Vergleiche). Das Vorliegen von Diabetes mellitus (23 % des Kollektivs) beeinflusste die perioperative Letalität nicht, während eine dialysepflichtige Niereninsuffizienz eine signifikant erhöhte Mortalität aufwies (p < 0,001 gegenüber Patienten mit Kreatinin ≤ 1,5 mg/dl; p = 0,002 gegenüber nicht dialysepflichtigen Patienten mit Kreatinin > 1,5 mg/dl). Patienten mit sekundärprophylaktischer ICD-Indikation wiesen eine signifikant höhere Mortalität auf (1,2 % vs. 0,4 %; p < 0,001), die sich beim Auftreten von Komplikationen von 0,6 % auf 3,7 % erhöhte (p < 0,001). Schlussfolgerung Die operationsbezogene Mortalität bei ICD-Implantation ist bei Patienten über 80 Jahre, hoher NYHA-Klasse, Dialysepflicht, sekundärprophylaktischer Indikation und nach Auftreten von Komplikationen erhöht.
Collapse
Affiliation(s)
- Harilaos Bogossian
- Klinik für Kardiologie und Rhythmologie, Ev. Krankenhaus Hagen, Brusebrinkstr. 20, 58135, Hagen, Deutschland. .,Universität Witten/Herdecke, Witten, Deutschland.
| | - Dimitrios Panteloglou
- Klinik für Kardiologie, Elektrophysiologie und Angiologie, Klinikum Lüdenscheid, Lüdenscheid, Deutschland
| | - Zana Karosiene
- Klinik für Kardiologie, Elektrophysiologie und Angiologie, Klinikum Lüdenscheid, Lüdenscheid, Deutschland
| | | | | | - Bernd Lemke
- Klinik für Kardiologie, Elektrophysiologie und Angiologie, Klinikum Lüdenscheid, Lüdenscheid, Deutschland
| | - Carsten W Israel
- Klinik für Kardiologie, Evangelisches Klinikum Bethel, Bielefeld, Deutschland
| |
Collapse
|