Читать книгу Recent Advances in Dialysis Therapy in Japan - Группа авторов - Страница 24

Again, we have believed and accepted the common sense theory that paroxysmal ventricular tachycardia and fibrillation are the central causes of SCD in HD patients because of their high prevalences of latent coronary artery disease [15] and cardiac functional morphological abnormalities [16], and they have a high rate of triggers for ventricular arrhythmias, such as volume expansion and electrolyte shifts, which occur routinely. However, a recent clinical study by an Australian group impressed us with the finding that all SCD events in HD patients were caused by bradycardia and asystole, such as SCA without ventricular arrhythmia and advanced atrioventricular block [17]. Even though their study had a small sample size, they explored the cause of death using a loop recorder, which is an implanted monitor used to identify the cause of syncope in clinical practice. During a 1-year follow-up period, they confirmed 5 SCD events, and a fatal bradyarrhythmia was recorded at the time of each event in 4 patients; this means that no fatal ventricular tachyarrhythmias were observed in 4 HD patients with SCD [17]. A similar finding was confirmed by a study from a Brazilian group, which showed a high frequency of fatal bradyarrhythmias on monitoring of loop recorders in 100 chronic HD patients [18]. We could make the unwarranted assumption that bradyarrhythmia is not a common cause of SCD. Indeed, it has been reported that a higher incidence of implantable pacemaker events was observed in HD patients than in the general population [19]. We need to pay more attention to bradyarrhythmias, such as advanced AV block and SCA.