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Am J Respir Crit Care Med. 2005 Jul 1;172(1):118-22. Epub 2005 Mar 4.

Atrial overdrive pacing in patients with sleep apnea with implanted pacemaker.

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1
Herzzentrum Göttingen, Abteilung Kardiologie und Pneumologie, Georg-August-Universität Göttingen, Robert-Koch-Strasse 40, 37075 Göttingen, Germany.

Abstract

RATIONALE:

Atrial overdrive pacing markedly improved sleep-disordered breathing in a recent study.

OBJECTIVES:

Using a single-blind, randomized, crossover design, we aimed to reproduce these findings and investigate the possible underlying mechanisms.

METHODS:

Twenty ambulatory patients with an implanted pacemaker or cardioverter defibrillator were studied by polysomnography on 3 consecutive nights in a randomized, single-blind, crossover study in which devices were programmed for nonpacing or for overdrive pacing at 7 or 15 beats/minute faster than the mean nocturnal heart rate. Ventilation and biomarkers (urinary norepinephrine excretion, amino-terminal portion of the precursor of brain natriuretic peptide, or NT-proBNP, were also evaluated.

MEASUREMENTS AND MAIN RESULTS:

Neither the primary endpoint apnea-hypopnea index, nor the apnea index, oxygen desaturation, ventilation, or biomarkers were affected by the nocturnal atrial overdrive pacing. A small, clinically insignificant, rate-dependent reduction in the hypopnea index was evoked by pacing (nonpacing, 13.4 +/- 1.4; pacing 7, 12.9 +/- 1.4; pacing 15, 10.9 +/- 1.0; p < 0.01, analysis of variance).

CONCLUSIONS:

The lack of effect on the apnea-hypopnea index means that atrial overdrive pacing is inappropriate for treating sleep-disordered breathing.

Comment in

PMID:
15750043
DOI:
10.1164/rccm.200409-1258OC
[Indexed for MEDLINE]
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