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Effects of adaptive servo-ventilation on ventricular arrhythmias in patients with stable congestive heart failure and sleep-disordered breathing

Subanalysis of a randomized controlled trial

Effekte einer adaptiven Servoventilation auf Herzrhythmusstörungen bei Patienten mit chronischer Herzinsuffizienz und schlafbezogenen Atmungsstörungen

Subanalyse einer randomisierten Studie

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Abstract

Background

Congestive heart failure patients with reduced left ventricular ejection fraction (HFrEF) and sleep-disordered breathing (SDB) are at an increased risk of nocturnal cardiac arrhythmias. SDB can be effectively treated with adaptive servo-ventilation (ASV). Therefore, we tested the hypothesis that ASV therapy reduces nocturnal arrhythmias and heart rate in patients with HFrEF and SDB.

Methods

In a non-prespecified subanalysis of a multicenter randomized controlled trial (ISRCTN04353156), 20 consecutive patients with stable HFrEF (age 67 ± 9 years; left ventricular ejection fraction, LVEF 32 ± 7 %) and SDB (apnea–hypopnea index, AHI 48 ± 20/h) were randomized to either an ASV therapy (n = 10) or an optimal medical treatment alone group (controls, n = 10). Polysomnography (PSG) with blinded centralized analysis and scoring was performed at baseline and at 12 weeks. The electrocardiograms (ECG) of the PSGs were analyzed with long-term (24-h) Holter ECG software (QRS-Card™ Cardiology Suite; Pulse Biomedical Inc., King of Prussia, PA, USA).

Results

There was a decrease in ventricular extrasystoles (VES) per hour of recording time in the ASV group compared to the control group (−8.1 ± 42.4 versus +9.8 ± 63.7/h, p = 0.356). ASV reduced the number of ventricular couplets and nonsustained ventricular tachycardias (nsVT) compared to the control group (−2.3 ± 6.9 versus +2.1 ± 12.7/h, p = 0.272 and −0.1 ± 0.5 versus +0.1 ± 1.1/h, p = 0.407, respectively). Mean nocturnal heart rate decreased in the ASV group compared to the controls (−2.0 ± 2.7 versus +3.9 ± 11.5/min, p = 0.169). The described changes were not significantly different between the groups.

Conclusion

In HFrEF patients with SDB, ASV treatment may reduce nocturnal VES, couplets, nsVT, and mean nocturnal heart rate. The findings of the present pilot study underscore the need for further analyses in larger studies.

Zusammenfassung

Hintergrund

Patienten mit chronischer Herzinsuffizienz und reduzierter linksventrikulärer Ejektionsfraktion (HFrEF) und schlafbezogenen Atmungsstörungen (SBAS) leiden häufig unter nächtlich auftretenden kardialen Arrhythmien. SBAS können effektiv mit einer adaptiven Servoventilation (ASV) behandelt werden. Wir überprüften daher die Hypothese, dass eine ASV-Therapie bei Patientenmit HFrEF und SBAS die Häufigkeit nächtlicher kardialer Arrhythmien und die Herzfrequenz reduziert.

Methoden

In einer nicht-präspezifizierten Subanalyse einer multizentrischen randomisierten Studie (ISRCTN04353156) wurden 20 Patienten mit stabiler HFrEF (Alter 67 ± 9 J; linksventrikulärer Ejektionsfraktion 32 ± 7 %) und SBAS (Apnoe-Hypopnoe-Index, AHI 48 ± 20/h) entweder einer ASV- (n = 10; Philips Respironics, Murrysville, PA, USA) oder einer Kontrollgruppe mit alleiniger optimaler Herzinsuffizienztherapie (n = 10) zugeteilt. Zu Beginn der Studie und nach 12 Wochen wurde jeweils eine Polysomnographie (PSG) mit zentraler verblindeter Auswertung durchgeführt. Die Elektrokardiogramme (EKG) der PSG wurden mit Unterstützung einer Langzeit-EKG-Software (Pulse Biomedical Inc., QRS-CardTM Cardiology Suite, USA) ausgewertet.

Ergebnisse

In der ASV-Gruppe nahmen ventrikuläre Extrasystolen (VES) pro Stunde Aufnahmezeit im Vergleich zur Kontrollgruppe ab (−8,1 ± 42,4 versus +9,8 ± 63,7/h, p = 0,356). Eine ASV-Therapie reduziert im Vergleich mit der Kontrollgruppe die Anzahl ventrikulärer Couplets (−2,3 ± 6,9 versus +2,1 ± 12,7/h, p = 0,272) sowie nichtanhaltender ventrikulärer Tachykardien (nsVT, −1,2 ± 3,9 versus +1,3 ± 8,7, p = 0,340). Die mittlere nächtliche Herzfrequenz sank in der ASV-Gruppe im Vergleich zur Kontrollgruppe (−2,0 ± 2,7 versus +3,9 ± 11,5/Minute, p = 0,169). Die Veränderungen waren jeweils nicht statistisch signifikant.

Schlussfolgerungen

Eine Beatmungstherapie mit ASV reduziert bei Patienten mit HFrEF und SBAS möglicherweise die Häufigkeit nächtlicher VES, ventrikulärer Couplets, nsVTs und die nächtlichemittlere Herzfrequenz. Die Ergebnisse der vorliegenden Pilotstudie unterstreichen die Notwendigkeit, diese Fragestellung in größeren Studien zu evaluieren.

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Authors and Affiliations

  1. Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany

    H.-J. Priefert, A. Hetzenecker MD, R. Luigart, C. Birner MD, M. Pfeifer MD & M. Arzt MD

  2. Centre de Médecine du Sommeil, Hopital Antoine Beclere, Clamart, France

    P. Escourrou MD

  3. Centre de Recherche, IUCPQ, Universite Laval, Quebec, Canada

    F. Series MD & A. Benjamin MD

  4. Department of Respiratory Medicine, Prince Philip Hospital and Swansea College of Medicine, Wales, United Kingdom

    K. Lewis MD

  5. Zentrum für Pneumologie, Klinik Donaustauf, Donaustauf, Deutschland

    M. Pfeifer MD

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  1. H.-J. Priefert
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  3. P. Escourrou MD
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  4. R. Luigart
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  5. F. Series MD
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  10. M. Arzt MD
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Corresponding author

Correspondence to M. Arzt MD.

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Conflict of interest

This study was supported by Philips Respironics. M. Arzt receives financial support for research activities from Philips Respironics, ResMed, and the ResMed Foundation, as well as speaker honoraria from Philips Respironics and ResMed. Prior to its current publication in this journal, this work was submitted by the first author to the Faculty of Medicine, University of Regensburg, in the form of a dissertation. H.-J. Priefert, A. Hetzenecker, P. Escourrou, R. Luigart, F. Series, K. Lewis, A. Benjamin, C. Birner and M. Pfeifer declare that they have no conflicts of interest.

All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies.

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The German version of this Article can be found under doi:10.1007/s11818-016-0059-3. Please refer there for the Clinical Trial Registration.

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Priefert, HJ., Hetzenecker, A., Escourrou, P. et al. Effects of adaptive servo-ventilation on ventricular arrhythmias in patients with stable congestive heart failure and sleep-disordered breathing. Somnologie 21 (Suppl 1), 19–27 (2017). https://doi.org/10.1007/s11818-016-0072-6

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