Cardiac Arrhythmia during Chronic Hemodialysis: A Cross-Sectional Holter ECG Study in Patients from North Cameroon

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ABSTRACTBackground. Cardiac arrhythmia is frequently observed in patients with end-stage renal disease (ESRD), and it is associated with a high morbidity and mortality, but ECG studies in this group are rare. The aim of our study was to describe the occurrence, severity, and risk factors of cardiac arrhythmia in patients with ESRD in the North Cameroon region. Methods. We carried out a cross-sectional study in the hemodialysis units of two regional hospitals in the cities of Maroua and Garoua, Cameroon. Over a four month period in 2015, we consecutively recruited consenting adult patients on maintenance hemodialysis for at least three months. A 24-hour Holter ECG monitor was placed just before dialysis. Ventricular arrhythmia was classified according to Lown classification. Results. 30 participants (63.3% males) were included in the study. Their mean age was 42 ± 15.7 years (range 30 – 67 years). Hypertension was the most frequent co-morbid condition, present in 21 cases (70%). On standard ECG, 25 patients (83.3%) had normal sinus rhythm while 5 (16.7%) had sinus tachycardia. The mean ejection fraction (EF) was 64.4 ± 15%, and ranged from 32 to 83%. The most frequent pericardial finding was effusion (46.6%). The overall average heart rate was 85.7 ± 14.8 bpm, and ranged from 62 to 120 bpm. The most frequent arrhythmia on Holter ECG was PVC of varying degrees seen in 26 (86.7%) of patients. This was followed by supraventricular premature contractions (21, [70%]), which were all junctional in origin. Of those with PVC, 12 (46.2%) had complex arrhythmia. Six (20%) patients had salves of Premature Ventricular Contractions (PVC). Conclusion. Complex Premature ventricular contractions frequently occurred in patients on maintenance hemodialysis. This was associated with left ventricular systolic dysfunction. This stresses the need for a comprehensive cardiac evaluation including Holter-ECG recordings this group of patients.RESUMEIntroduction. Les troubles du rythme cardiaques sont frequemment observes chez les patients en insuffisance renale chronique terminale (IRCT) et sont associes a une grande morbimortalite. Le but de notre etude etait d’identifier les principaux troubles du rythme cardiaque au HOLTER ECG de 24H chez les patients hemodialyses chroniques suivis dans deux centres d’hemodialyse au Nord Cameroun. Methodes. Notre etude transversale descriptive a ete menee dans 2 centres d’hemodialyse au Nord Cameroun (Garoua et Maroua) de Fevrier a Mai 2015.Tous les patients hemodialyses depuis plus de 03 mois ayant accepte de participer a l’etude ont ete inclus. Un enregistrement electrocardiographique de longue duree (HOLTER ECG) a ete realise pendant 24H et debutait peu avant chaque seance de dialyse. Les extrasystoles ventriculaires (ESV) ont ete classees selon la classification de LOWN. Resultats. 30 patients ont ete retenus. La moyenne d’âge etait de 42±15,65 ans, et les hommes representaient 63,3% de l’effectif. La principale comorbidite retrouvee etait l’hypertension arterielle (21 patients ,70%). A l’ECG standard 25 patients etaient en rythme sinusal normal tandis que 5 patients etaient en tachycardie sinusale. A l’echodoppler cardiaque la fraction d’ejection ventriculaire gauche moyenne etait de 64.4 ± 15%. On a retrouve dans 46% des cas un epanchement pericardique. Au Holter ECG la frequence cardiaque moyenne de 24h etait de 85.7 ± 14.8 bpm. Parmi les troubles du rythme detectes, les ESV etaient presentes dans 86,7% des cas dont 46,2% etaient classees comme complexes. Les extrasystoles supraventriculaires (ESSV) etaient retrouvees chez 70% des patients. Parmi les 12 (46,2%) patients qui avaient des ESV complexes, 6 patients avaient des salves d’ESV. Conclusion. Les ESV sont frequentes chez les patients hemodialyses chroniques. Ces ESV sont associees a une alteration de la fonction systolique ventriculaire gauche. Cela souligne la necessite d'une evaluation cardiaque complete incluant un enregistrement Holter-ECG de 24h chez ce groupe de patients.

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