Abstract
Twenty-four-hour electrocardiographic monitoring (Holter ECG) and echocardiographic studies were performed in 185 patients including 100 patients on maintenance hemodialysis (HD) and 26 patients on continuous ambulatory peritoneal dialysis (CAPD). Electrocardiographic monitoring revealed atrial premature contraction (APC) in 87 HD patients (87%) and ventricular premature contraction (VPC) in 58 HD patients (58%). Twenty-two HD patients (22%) showed more than 100 APC beats/day and potentially hazardous VPC such as Lown's grade 3-5 were observed in 26 HD patients (26%). VPC tends to be more frequently influenced by hemodialysis per se in comparison with APC. The age, left ventricular dimension and ejection fraction in HD patients with frequent APC were significantly different from those in patients without APC. The left ventricular dimension and left ventricular wall thickness were significantly increased in HD patients with frequent VPC, as compared with those in patients without VPC. Bradycardial atrial fibrillation was the most frequent type of bradycardial rhythm disturbance. Advanced AV block was the major reason for permanent pacemaker (PM) implantation in HD patients before initiation of HD, while sick sinus syndrome was the main reason for PM implantation after initiation of HD. Although it seemed very difficult to place sufficient load on HD patients in exercise testing and some problems still remain with regard to evaluation of the results, exercise testing showed no sign of ischemia in HD patients who developed VPC during HD without apparent heart disease.
