Hemodialysis (HD) is a clinical procedure used to treat patients suffering of chronic kidney failure. Unfortunately, HD patients are at a high risk of sudden cardiac death (SCD). To evaluate SCD risk, it is useful to analyze the electrocardiographic signal (ECG). One of the most popular indexes to investigate SCD is T-wave alternans (TWA), related to the ventricular repolarization segment of the ECG. Electrocardiographic alternans (ECGA), i.e. the prevalent nature of electrical alternans, though, represents a more complete analysis of the cardiac electrical activity, including also the possible presence of alternans on P wave (PWA) and QRS (QRSA), related to atrial depolarization and repolarization phases, respectively. Aim of this study was to obtain a complete evaluation of ECGA on a HD patient during a HD day, by means of the Heart-Rate Adaptive Match filter (HRAMF) method. HRAMF was applied for ECGA analysis on a continuous Holter ECG recording. Considering four macro-time periods PRE-HD, IN-HD, POST-HD and NT-HD (before, during, after HD and during the night, respectively), ECGA was identified as TWA and presented high values (>15µV) in PRE-HD (51 µV) and IN-HD (53 µV), highlighting how these periods are characterized by a higher SCD risk. Two hours after the end of HD, ECGA decreased due to the treatment, able to rebalance electrolytes concentrations. Statistical differences were found between PRE-HD and POST-HD, and PRE-HD and NT-HD (p<10-3). The study suggested a higher cardiac risk (mostly affecting ventricular repolarization) in HD patients; this risk is lower after the end of HD session.
Electrocardiographic Alternans in Hemodialysis: A Case Report / Marcantoni, I.; Di Monte, J.; Leoni, C.; Mansour, Z.; Sbrollini, A.; Morettini, M.; Burattini, L.. - ELETTRONICO. - (2020), pp. 228-231. (Intervento presentato al convegno 7th National Congress of Bioengineering, GNB 2020 nel 2020).