QT dispersion in patients with end-stage renal failure and during hemodialysis

Istán Lorincz, J. Mátyus, Zsolt Zilahi, Csaba Kun, Z. Karányi, G. Kakuk

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Abstract

Interlead variability of the QT interval in surface electrocardiogram (ECG), i.e., QT dispersion, reflects regional differences in ventricular recovery time, and it has been linked to the occurrence of malignant arrhythmias in different cardiac diseases. The purpose of the study was to assess the effect of hemodialysis on QT and corrected QT (QTc) interval and dispersion in chronic hemodialyzed patients. Data of 34 nondiabetic patients (male/female = 21/13; mean age, 54 ± 15 yr) on chronic hemodialysis were studied. Polysulfone capillaries and bicarbonate dialysate containing (in mEq/L) 135 Na+, 2.0 K+, 1.5 Ca2+, and 1.0 M2+ were used. Simultaneous 12-lead ECG were recorded before and after hemodialysis in a standard setting. The QT intervals for each lead were measured manually on enlarged (X3) ECG by one observer using calipers. Each QT interval was corrected for patient heart rate: QTc = QT/√RR (in milliseconds [ms]). The average cycle intervals were 853 ± 152 ms predialysis and 830 ± 173 ms postdialysis; the difference was not significant. The maximal QT interval changed significantly from 449 ± 43 to 469 ± 41 ms (P <0.01). The corrected maximal QT interval increased significantly from 482 ± 42 to 519 ± 33 ms (P <0.01). The QT dispersion changed from 56 ± 15 to 85 ± 12 ms (P <0.001) and the corrected QT interval dispersion from 62 ± 18 to 95 ± 17 ms (P <0.001). During hemodialysis, the serum potassium and phosphate levels decreased from 5.5 ± 0.8 to 3.9 ± 0.5 (mM) and from 2.3 ± 0.5 to 1.6 p 0.4 (mM), respectively, whereas calcium increased from 2.2 ± 0.23 to 2.5 ± 0.22 (mM). It is concluded that hemodialysis increases the QT and QTc interval and QT and QTc dispersion in patients with end-stage renal failure. Thus, it may be stated that the nonhomogeneity of regional ventricular repolarization increases during hemodialysis. Measurement of QT and QTc dispersion is a simple bedside method that can be used for analyzing ventricular repolarization during hemodialysis.

Original languageEnglish
Pages (from-to)1297-1302
Number of pages6
JournalJournal of the American Society of Nephrology
Volume10
Issue number6
Publication statusPublished - Jun 1999

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Chronic Kidney Failure
Renal Dialysis
Electrocardiography
Dialysis Solutions
Bicarbonates
Cardiac Arrhythmias
Heart Diseases
Heart Rate
Calcium
Serum

ASJC Scopus subject areas

  • Nephrology

Cite this

QT dispersion in patients with end-stage renal failure and during hemodialysis. / Lorincz, Istán; Mátyus, J.; Zilahi, Zsolt; Kun, Csaba; Karányi, Z.; Kakuk, G.

In: Journal of the American Society of Nephrology, Vol. 10, No. 6, 06.1999, p. 1297-1302.

Research output: Contribution to journalArticle

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N2 - Interlead variability of the QT interval in surface electrocardiogram (ECG), i.e., QT dispersion, reflects regional differences in ventricular recovery time, and it has been linked to the occurrence of malignant arrhythmias in different cardiac diseases. The purpose of the study was to assess the effect of hemodialysis on QT and corrected QT (QTc) interval and dispersion in chronic hemodialyzed patients. Data of 34 nondiabetic patients (male/female = 21/13; mean age, 54 ± 15 yr) on chronic hemodialysis were studied. Polysulfone capillaries and bicarbonate dialysate containing (in mEq/L) 135 Na+, 2.0 K+, 1.5 Ca2+, and 1.0 M2+ were used. Simultaneous 12-lead ECG were recorded before and after hemodialysis in a standard setting. The QT intervals for each lead were measured manually on enlarged (X3) ECG by one observer using calipers. Each QT interval was corrected for patient heart rate: QTc = QT/√RR (in milliseconds [ms]). The average cycle intervals were 853 ± 152 ms predialysis and 830 ± 173 ms postdialysis; the difference was not significant. The maximal QT interval changed significantly from 449 ± 43 to 469 ± 41 ms (P <0.01). The corrected maximal QT interval increased significantly from 482 ± 42 to 519 ± 33 ms (P <0.01). The QT dispersion changed from 56 ± 15 to 85 ± 12 ms (P <0.001) and the corrected QT interval dispersion from 62 ± 18 to 95 ± 17 ms (P <0.001). During hemodialysis, the serum potassium and phosphate levels decreased from 5.5 ± 0.8 to 3.9 ± 0.5 (mM) and from 2.3 ± 0.5 to 1.6 p 0.4 (mM), respectively, whereas calcium increased from 2.2 ± 0.23 to 2.5 ± 0.22 (mM). It is concluded that hemodialysis increases the QT and QTc interval and QT and QTc dispersion in patients with end-stage renal failure. Thus, it may be stated that the nonhomogeneity of regional ventricular repolarization increases during hemodialysis. Measurement of QT and QTc dispersion is a simple bedside method that can be used for analyzing ventricular repolarization during hemodialysis.

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