Temporal Changes in Atrial Fibrillation and Atrial Flutter Prevalence in Patients with ESKD Following Arteriovenous Fistula Placement

Background: End-stage kidney disease (ESKD) patients have a high burden of cardiovascular disease, including hypertension, congestive heart failure, and coronary artery disease, which are known risk factors for atrial fibrillation and atrial flutter (AF/AFL). While the prevalence and predictors of AF/AFL have been studied in various populations, their occurrence and evolution in patients with ESKD remains unclear. Methods: We conducted a retrospective cohort study in 196 consecutive ESKD patients who underwent arteriovenous (AV) fistula placement. The prevalence and predictors of AF/AFL were analyzed before and after AV fistula placement. The study was approved by the Institutional Review Board (IRB). Results: The study population included 40% females, 60.7+/-14.6 years old, with BMI 28.3+/-6.6 and histories of hypertension (HTN) in 91.3%, coronary artery disease (CAD) in 46.9%, atrial fibrillation in 35.2%, diabetes mellitus (DM) in 63.7%, and congestive heart failure (CHF) in 50%. The maximum time difference between the first and the second ECGs was 137 months, with a mean of 34+/-27 months. At baseline, patients with AF/AFL were significantly older (p<0.001) and had a prior history of AF/AFL (p<0.001), while traditional arrhythmia risk factors, e.g. HTN, CAD, DM, or CHF were not associated with arrhythmia. During the study interval, ESKD patients experienced a 3-fold increase in the prevalence of AF/AFL after AV fistula placement, from 4% on baseline to 11% on the follow-up ECGs (p<0.001). At the follow-up and after AV fistula placement, none of the traditional AF/AFL risk factors were linked with arrhythmia. Conclusion: Prevalence of AF/AFL is significantly increased in ESKD patients following AV fistula placement. Traditional risk AF/AFL predictors do not appear to be important in these ESKD patients. Further studies of effects of AV fistula placement on arrhythmia are warranted in ESKD patients.