Insights into intradialytic atrial fibrillation onset mechanisms

摘要

To the Editor, It is with interest that we read the paper by Buiten et al in which the authors, using the implantable cardioverter defibrillator (ICD) remote monitoring function in patients enrolled in the ICD-2 trial, showed that haemodialysis (HD) is a trigger for atrial fibrillation (AF) episodes. The study of Buiten confirms some observations we made in the recent past. A few years ago we studied, by high-frequency electrocardiography, the effects of the HD session on P-wave duration (Pwd), an expression of intra-atrial conduction velocity, demonstrating that the procedure induced a prolongation of Pwd closely related to the reduction of the plasma potassium concentration. When the predialysis and postdialysis values of electrolytes were put in a computational model that simulates the atrial action potential, the atrial potential upstroke was slowed down from the beginning towards the end of the HD session. Also, we observed a reduction of the effective refractory period. It is well known that both phenomena are part of the electrical remodelling at the base of AF onset.