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Heart Rhythm. 2019 Jan;16(1):91-97. doi: 10.1016/j.hrthm.2018.07.027. Epub 2018 Jul 27.

Adaptive servo-ventilation reduces atrial fibrillation burden in patients with heart failure and sleep apnea.

Author information

1
Department of Medicine, Duke University and Duke Clinical Research Institute, Durham, North Carolina. Electronic address: jonathan.piccini@duke.edu.
2
Department of Medicine, Duke University and Duke Clinical Research Institute, Durham, North Carolina.
3
Department of Cardiology, Ruhr University Bochum, Bad Oeynhausen, Germany.
4
Department of Medicine, Johns Hopkins University, Baltimore, Maryland.
5
Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania.
6
Department of Medicine, Vanderbilt University, Nashville, Tennessee.
7
ResMed Science Center, ResMed, San Diego, California.
8
Department of Medicine, Duke University and Duke Clinical Research Institute, Durham, North Carolina; Inova Heart and Vascular Institute, Falls Church, Virginia.

Abstract

BACKGROUND:

Patients with heart failure and sleep apnea are at increased risk for developing arrhythmias. Whether treatment of sleep apnea reduces arrhythmias is unknown.

OBJECTIVE:

The purpose of this study was to determine whether adaptive servo-ventilation (ASV) with optimal medical therapy (OMT) reduces atrial fibrillation (AF) and/or ventricular tachycardia/ventricular fibrillation (VT/VF) burden compared to OMT alone.

METHODS:

We conducted a prospective substudy of patients with pacemakers/defibrillators in the Cardiovascular Improvements with Minute Ventilation-Targeted ASV Therapy in Heart Failure (CAT-HF) trial. Change in arrhythmia burden was compared using a mixed model analysis to account for multiple measurements per patient.

RESULTS:

Among 35 randomized patients eligible and analyzed (19 ASV, 16 OMT only) in the AF cohort, mean age was 64 ± 12 years, 23% were women (n = 8), 49% had previous AF (n = 17), 89% had reduced ejection fraction (n = 31), and mean apnea hypopnea index was 41 ± 17 events per hour. Baseline characteristics were similar between groups. Change in AF burden from baseline to follow-up was -15.8% ± 36.5% with ASV vs +23.7% ± 36.2% with OMT (P = .034). There was no significant change in the AF cohort in the mean number of VT/VF events: +3.3 ± 14.9 events with ASV vs -0.3 ± 7.3 events with OMT (P = .58). Five subjects had appropriate therapies for VT/VF in the ASV arm vs 6 subjects in the OMT arm.

CONCLUSION:

This study provides proof of concept that treatment of sleep apnea with ASV leads to reduction in AF burden compared with OMT alone, without an increase in VT/VF events. This hypothesis should be tested in a large outcomes trial.

KEYWORDS:

Arrhythmia; Atrial fibrillation; Cardiac implanted electronic device; Heart failure; Randomized clinical trial; Sleep apnea

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