Ageing: A Possible Clue to the Arrhythmogenic Effect of Hemodyalisis

Raffaele Antonelli Incalzi, MD, Department of Gerontology, Catholic University of the Sacred Heart, Largo Agostino Gemelli 8, I-00168 Rome (Italy) Dear Sir, Following the interesting letter by Quereda et al. [1], we analyzed the Holier recordings of 20 uremic patients in order to assess the relation, if any, between hemodialy-sis (HD) and arrhythmias. A significant arrhythmogenic effect of HD was demonstrated, but it lasted for only 2 h after completing HD (fig. 1). Six patients with arrhythmias exceeding the ΠB class of Myerburg [2] (1–9 polyfo-cal ventricular ectopic beats per hour) were particularly vulnerable to the arrhythmogenic effect of HD. Interestingly, only the mean age distinguished these patients from the remaining 14 (65.4 ± 9.2 vs. 53.6 ± 2.1 years; p < 0.05). In fact, no further difference between groups was found in sex distribution, smoking habits, serum lipids, drug consumption, ethiology of the chronic renal failure, duration of the HD treatment, pre-HD blood chemistry and HD-related changes including ionized calcium, incidence of diabetes, hypertension, and coronary artery disease (as evaluated by history, basal and effort electrocardiogram, and echocardiogram). We conclude that HD may be regarded as an arrhythmogenic procedure, mostly in the elderly. Accordingly, the mean age should always be taken into account when comparing results on this subject. References Quereda, C; Orte, L.; Martesanz, R.; Ortuño, J.: Ventricular ectopic activity in hemodialysis. Nephron 42:181 -182 (1986). Myerburg, R.J.: Classification of ventricular arrhythmias based on parallel hierarchism of frequency and form. Am. J. Cardiol. 54:1355–1358(1984).