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Bradycardia and Asystole in CKD
Bradycardia and Asystole in CKD
12, 2015
Letters
Electrocardiograms demonstrating severe bradycardia with ensuing asystole at time of death that were retrieved from the implantable cardiac
monitor of a sudden cardiac death patient.
An additional patient was successfully resuscitated the rst time that the vast majority of SCD are
after experiencing an in-hospital cardiac arrest with due to bradycardia and asystole, rather than malig-
sustained monomorphic VT after presenting with an nant ventricular arrhythmias. These observations
acute coronary syndrome. There were no cases of raise the key question of whether bradycardia/asys-
polymorphic VT or ventricular brillation recorded. tole as the terminal rhythm represents a primary
There were 1,488 signicant arrhythmia events electrical event, or alternatively, a manifestation
occurring in 22 patients (44%): bradycardia in 12 of end-stage, irreversible myocardial failure in the
(24%); sinus arrest in 10 (20%); 2 AV block in 2 setting of profound biochemical, metabolic, and
(4%); and nonsustained VT in 8 (16%). The nal day structural disarray. These observations have poten-
of the LIDP had more events than all other days tial implications for strategies to minimize SCD in
(p < 0.001 by analysis of variance). this population, the prescription of hemodialysis
In CKD patients on hemodialysis who have pre- to minimize the LIDP, and the role of beta-blockers
served LV function, our study demonstrates for in CKD.
JACC VOL. 65, NO. 12, 2015 Letters 1265
MARCH 31, 2015:126371