Nephrol Dial Transplant Vol. 20 No. 2 © ERA–EDTA 2005; all rights reserved
Letter
DC cardioversion during continuous veno-venous haemofiltration
Sir,Recently, we delayed starting continuous veno-venous haemofiltration (CVVH) treatment because we were reluctant to perform direct current (DC) cardioversion during CVVH. In the end, it proved to be no problem.
Case. A 15-year-old, previously healthy, girl was admitted with acute fulminate liver failure of unknown origin. She received an orthotopic liver transplantation without any subsequent problems. One day post-operatively, she was hypotensive in spite of noradrenaline, and became anuric with normal blood electrolytes, but rising BUN and creatinine. Furthermore, she developed an atrial flutter with a heart rate of 180 b.p.m. for which medical treatment was started.
It was decided to start renal replacement therapy. Because of her circulatory problems, we opted for CVVH treatment. However, as there was nearly no reaction to the d-sotalol given for the atrial flutter, there was a possible need for DC cardioversion.
We were all reluctant to try cardioversion during CVVH because it was not clear whether the system was adequately protected against electric cardioversion.
In the literature, we could not find any publications in which it was stated if this would give any problems. Therefore, we delayed the start of the CVVH treatment.
After several hours, when the heart rhythm seemed to normalize, we started CVVH. Unfortunately, after another few hours, she deteriorated again and DC cardioversion was needed. We phoned Hospal®, the makers of the CVVH machine. They said there should be no problem although, according to them, it had never been tried before. It was stated in the machine description that there would be no interaction. Indeed there was no problem at all. Our patient was cardioverted (20 J, 50 J, 50 J) without any change in blood flow or on the CVVH machine, and 3 h later had to be cardioverted again (50 J, 70 J).
After each cardioversion, the atrial flutter reinitiated after a short period. Finally, normal sinus rhythm was obtained with amiodarone. The patient recovered completely.
Comment. DC cardioversion during CVVH treatment led to no interference in our setting. After all, we delayed the CVVH treatment unnecessarily.
Conflict of interest statement. None declared.
Departments of 1 Paediatric Nephrology and 2 Paediatric Cardiology Beatrix Children's Hospital University Hospital Groningen The Netherlands Email: i.j.m.nijhuis{at}bkk.azg.nl
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