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Factores implicados en el desarrollo de arritmias ventriculares potencialmente fatales en pacientes bajo tratamiento de hemodiálisis
Resumen
Introducción: Los pacientes en hemodiálisis exhiben una frecuencia muy elevada de mortalidad de origen cardiaco. Objetivo: Describir los principales factores implicados en el desarrollo de arritmias ventriculares potencialmente fatales en pacientes bajo tratamiento de hemodiálisis. Material y Métodos: Se realizó una búsqueda bibliográfica a partir de las palabras clave seleccionadas en la base de datos MEDLINE y SciELO disponibles en la red de INFOMED. En la búsqueda se encontraron 150 artículos del tema en cuestión referidos en los últimos 30 años, de los cuales 66 fueron referenciados en este trabajo. Se utilizaron Pubmed y Scielo como motores de búsqueda. Desarrollo: La hemodiálisis es capaz de inducir isquemia miocárdica y potencialmente conducir a fallo cardiaco, precipitando la aparición de arritmias ventriculares. Un grupo de factores ha sido implicado en la génesis de estas arritmias; sin embargo, los efectos arritmogénicos de la hemodiálisis no han sido uniformemente documentados. La enfermedad cardiaca preexistente y la presencia de factores que actúan como disparadores, algunos de los cuales pueden predominar, son probablemente los mecanismos implicados en el desarrollo de arritmias. Conclusiones: Los factores de mayor importancia implicados en la aparición de arritmias fatales durante la hemodiálisis son la hipertrofia ventricular izquierda asociada a disfunción ventricular; la enfermedad de arterias coronarias preexistente; la isquemia cardiaca aguda inducida por la hemodiálisis; las variaciones abruptas de las concentraciones de electrolitos y la sobreactividad simpática.
Palabras clave: Hemodiálisis, arritmias ventriculares, enfermedad renal crónica terminal, síndrome cardiorenal, muerte súbita, monitorización Holter, electrocardiograma
ABSTRACT
Introduction: Hemodialysis patients have very high cardiac mortality rates. Objective: To describe the most important factors implicated in the development of ventricular arrhythmias in patients under hemodialysis treatment. Material and Methods: A bibliography searching was performed using the selected key words from the Medline database and SciELO available on INFOMED network. In order to find this information, Pubmed and Scielo were used as search engine. 115 scientific articles during last thirsty years were found, 66 of them were referenced in this review. Development: Hemodialysis is capable of inducing myocardial ischemia and potentially leading to heart failure, precipitating ventricular arrhythmia. A number of factors have been implicated in the genesis of these arrhythmias; however, the arrhythmogenic effect of dialysis has not been uniformly documented. It seems to be that the presence of preexisting cardiac disease and the interaction of multiple factors that act as trigger, some of which prime for the development of arrhythmias, are likely the most important mechanisms implicated in the pathogenesis of arrhythmias in dialysis patients. Conclusions: Factors assuming greater importance in the development of life-threatening ventricular arrhythmias in hemodialysis patients may include left ventricular hypertrophy associated with ventricular dysfunction; preexisting coronary artery disease; dialysis-inducedacute cardiac ischemia; abrupt electrolytes concentration shift and sympathetic over activity.
Key words: Hemodialysis, ventricular arrhythmias, end-stage renal disease, cardiorenal syndrome, sudden cardiac death, Holter monitoring, electrocardiogram.
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