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ORIGINAL ARTICLE

The dialysis procedure as a trigger for atrial fibrillation: new insights in the development of atrial fibrillation in dialysis patients M S Buiten,1 M K de Bie,1 J I Rotmans,2 B A Gabreëls,3 W van Dorp,4 R Wolterbeek,5 S A Trines,1 M J Schalij,1 J W Jukema,1 T J Rabelink,2 L van Erven1 1

Department of Cardiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands 2 Department of Nephrology, LUMC, Leiden, The Netherlands 3 Department of Nephrology, Rijnland Hospital, Leiderdorp, The Netherlands 4 Department of Nephrology, Kennemer Gasthuis, Haarlem, The Netherlands 5 Department of Medical Statistics, LUMC, Leiden, The Netherlands Correspondence to Dr L van Erven, Department of Cardiology, Leiden University Medical Center, P O Box 9600, Leiden 2300 RC, The Netherlands; [email protected] Received 18 December 2013 Revised 29 January 2014 Accepted 3 March 2014 Published Online First 26 March 2014

ABSTRACT Aims Atrial fibrillation (AF) is common in dialysis patients and is associated with increased morbidity and mortality. The pathophysiology may be related to common risk factors for both AF and renal disease or to dialysis-specific factors. The purpose of this study was to determine whether and how AF onset relates to the dialysis procedure itself. Methods All dialysis patients enrolled in the implantable cardioverter defibrillator-2 (ICD-2) trial until January 2012, who were implanted with an ICD, were included in this study. Using the ICD remote monitoring function, the exact time of onset of all AF episodes was registered. Subsequently, this was linked to the timing of dialysis procedures. Results For the current study, a total of 40 patients were included, follow-up was 28±16 months, 80% male, 70±8 years old. A total of 428 episodes of AF were monitored in 14 patients. AF onset was more frequent on the days of haemodialysis (HD) ( p