Source
Department of Internal Medicine, University of Cincinnati College of Medicine and, Department of Veterans Affairs Medical Center, Medical Director, Sleepcare Diagnostics, Cincinnati, OH.
Abstract
ABSTRACT
BACKGROUND:
Excess sudden death (SD) due to ventricular tachyarrhythmias remains a major mode of mortality in patients with systolic heart failure. The aim of this study was to determine the association of nocturnal ventricular arrhythmias in patients with low ejection fraction heart failure. We incorporated a large number of known pathophysiological triggers to identify potential targets for therapy to reduce the persistently high incidence of SD in this population in spite of contemporary treatment.
METHODS:
86 ambulatory male patients with stable low (≤ 45%) EF heart failure underwent full-night attendant polysomnography and simultaneous Holter recordings. Patients were divided into groups according to presence or absence of couplets (paired premature ventricular excitations, PVEs), and ventricular tachycardia (VT) (≥ three consecutive, PVEs) during sleep. In multiple regression analysis four variables, current smoking status, increased number of arousals, plasma alkalinity and old age were associated with VT and two variables, AHI and low right ventricular EF were associated with couplets during sleep.
CONCLUSION:
We speculate that cessation of smoking; effective treatment of sleep apnea and plasma alkalosis could collectively decrease the incidence of nocturnal ventricular tachyarrhythmias and the consequent risk of SD which remains high in spite of use of beta blockades.