Arrhythmias and conduction disturbances
Usefulness of Sleep-Disordered Breathing to Predict Occurrence of Appropriate and Inappropriate Implantable-Cardioverter Defibrillator Therapy in Patients With Implantable Cardioverter-Defibrillator for Primary Prevention of Sudden Cardiac Death

https://doi.org/10.1016/j.amjcard.2013.01.277Get rights and content

Advanced heart failure (HF) is associated with severe sleep-disordered breathing (SDB). In addition, most patients with HF are treated with an implantable cardioverter-defibrillator (ICD) for primary prevention of sudden cardiac death. The incidence of ICD therapy in such a patient cohort with SDB has never been investigated. The present study sought to determine the effect of SDB on the incidence of appropriate and inappropriate ICD therapy in patients with a categorical primary prevention ICD indication. A total of 133 consecutive ICD patients with New York Heart Association class II-III HF and depressed left ventricular function (≤35%) with no history of ventricular arrhythmia underwent a sleep study before ICD implantation and were followed for 24 ± 8 months, prospectively. A relevant SDB was defined as an apnea-hypopnea index of ≥10 events/hour. Of these 133 patients, 82 (62%) had SDB. Overweight (body mass index >29.1 vs 24.7 kg/m2; p <0.001) was identified as the only independent risk factor for SDB. Appropriate ICD therapy intervention was significantly greater among patients with SDB than among patients without SDB (54% vs 34%, p = 0.03). Inappropriate ICD therapy intervention was documented more often in patients with SDB (n = 24 [29%] vs 7 [14%]; p = 0.04). An apnea-hypopnea index >10 events/hour was an independent predictor of appropriate ICD therapy on multivariate analysis (odds ratio 2.5, 95% confidence interval 1.8 to 4.04; p = 0.01). In conclusion, the present study is the first trial exploring the effect of SDB on the incidence of appropriate and inappropriate ICD therapy in patients with HF with a primary prevention indication. These results indicate that a preimplantation sleep study will identify patients with HF prone to receive appropriate and inappropriate ICD therapy.

Section snippets

Methods

The present prospective observational study focused in its primary end point on the investigation of the effect of SBD on the occurrence of appropriate ICD therapy for any ventricular tachyarrhythmia (VA). As a secondary end point, we evaluated the influence of several co-morbidities on the incidence of SDB. Another secondary end point tried to discover the influence of SDB on the incidence of inappropriate ICD interventions. Finally, we compared the period until the occurrence of the first

Results

During a median follow-up of 24 ± 8 months, 133 consecutive primary prevention ICD recipients with New York Heart Association class II-III HF participated in the present study. Their demographics are listed in Table 2.

We diagnosed SDB in 82 patients (62% of the whole collective). Appropriate ICD therapies for VA were significantly greater among patients with SDB than among patients without SDB (54% vs 34%, p = 0.03; Figure 1). The presence of SDB was the only significant univariate predictor of

Discussion

Any physician managing primary prevention of sudden cardiac death has been confronted as an increasing number of potential ICD recipients. Most of these patients never experience life-threatening arrhythmias. Therefore, it would be desirable to optimize the mechanisms to identify patients with an increased risk of malignant arrhythmias. The present study was intended to find new effective tools to identify patients with HF after primary prevention ICD implantation with an enhanced risk of

References (27)

  • A.J. Moss et al.

    Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction

    N Engl J Med

    (2002)
  • G.H. Bardy et al.

    Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure

    N Engl J Med

    (2005)
  • A.E. Buxton et al.

    A randomized study of the prevention of sudden death in patients with coronary artery disease. Multicenter Unsustained Tachycardia Trial Investigators

    N Engl J Med

    (1999)
  • Cited by (33)

    • Spatial QRS-T angle in patients with newly diagnosed obstructive sleep apnea syndrome

      2017, Advances in Medical Sciences
      Citation Excerpt :

      Moreover, OSAS was associated with nocturnal episodes of ST-segment depression, even in patients without established ischemic heart disease [4]. Significant correlations have also been observed between OSAS severity and ventricular premature beats, non sustained ventricular tachycardia, discharges of implantable cardioverter-defibrillators and increased risk of sudden cardiac death (SCD) [5–9]. The spatial QRS-T angle (QRS-TA) is known to predict cardiovascular death, death from any cause, and cardiovascular incidents not resulting in death.

    • Sleep-Disordered Breathing and Arrhythmia in Heart Failure Patients

      2017, Sleep Medicine Clinics
      Citation Excerpt :

      However, the literature in this field is heterogeneous to the present day.77,96 Although some studies supported our finding and identified SDB as a risk factor for malignant arrhythmic events,96 a study by Grimm and colleagues did not.77 Besides these data, the resulting discrepancy may be explained by the different patient selection criteria used in the differing studies.77,96

    • Sleep-Disordered Breathing and Cardiac Arrhythmias

      2015, Canadian Journal of Cardiology
      Citation Excerpt :

      In 255 patients screened for SDB 6 months after implantation of a cardiac resynchronization device with defibrillator, we found an independent association between SDB and appropriate defibrillator therapies during a 48-month follow-up period (Fig. 2).76 Two recently published investigations on CHF patients with implanted ICD devices showed divergent results: Kreuz et al.77 identified SDB as a risk factor for malignant arrhythmic events, and Grimm and coworkers68 did not, a discrepancy possibly caused by different patient selection criteria. However, device recipients also face an enhanced risk of being affected by inappropriate shocks, for instance, due to misdiagnosed supraventricular arrhythmias, sinus tachycardia, or technical problems within the device.

    • Should All Congestive Heart Failure Patients Have a Routine Sleep Apnea Screening? Pro

      2015, Canadian Journal of Cardiology
      Citation Excerpt :

      Furthermore, such an investigative strategy is expected to reduce overall CHF-related cost through the improvement of several factors accounting for the high medical and societal cost of CHF (ventricular tachycardia, hospital readmission, death)43 with the cure of SDB. Identification and treatment of SDB in CHF patients should also contribute to improve the efficacy of highly expensive therapy such as implantable cardioverter-defibrillator therapy.8 Compliance to treatment could certainly be an issue but it must be acknowledged that this is also the case for drug therapy44 and sodium/fluid restriction.

    View all citing articles on Scopus

    See page 1323 for disclosure information.

    View full text