RT Journal Article
SR Electronic
T1 Adaptive servoventilation reduces the risk of malignant arrhythmic events in patients with congestive heart failure and Cheyne-Stokes respiration
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP p1745
VO 38
IS Suppl 55
A1 Thomas Bitter
A1 Nina Westerheide
A1 Georg Nölker
A1 Klaus-Jürgen Gutleben
A1 Jürgen Vogt
A1 Johannes Heintze
A1 Dieter Horstkotte
A1 Jost Niedermeyer
A1 Olaf Oldenburg
YR 2011
UL http://erj.ersjournals.com/content/38/Suppl_55/p1745.abstract
AB Cheyne-Stokes respiration (CSR) is an independent risk factor for malignant arrhythmias in patients (pts) with congestive heart failure (CHF). The aim of this study was to investigate whether treatment of CSR with Adaptive Servoventilation (ASV) reduced the risk of malignant arrhythmic events in pts with CHF.403 pts with CHF (LVEF ≤ 45%, NYHA-class ≥ 2) and an implanted CRT-D or ICD device underwent overnight polygraphy with 221 having mild or no CSR (Apnea Hypopnea Index (AHI) < 15/h), and 182 having moderate to severe CSR (AHI > 15/h). Those with CSR were offered therapy with ASV accepted by 96 and rejected by 86 pts. During follow-up (48 months) CRT or ICD monitored ventricular arrhythmias and cardioversion events were recorded in addition to clinical and physiologic measures of heart failure severity.Event-free survival from a) appropriately monitored ventricular arrhythmias and b) appropriate cardioverter-defibrillator therapies was shorter in the untreated CSR group compared to the treated CSR and the no CSR group. Stepwise Cox proportional hazard regression analysis showed untreated CSR (a: HR 1.99, 95%CI 1.46-2.72, p<0.001; b: HR 2.19, 95%CI 1.42-3.37, p<0.001), but not treated CSR (a: HR 1.06, 95%CI 0.74-1.50; p=0.77; b: HR 1.21, 95%CI 0.75-1.93, p=0.43) was an independent risk factor.Conclusion: In pts with CHF and CRT/ICD the presence of untreated CSR is a risk factor for malignant arrhythmias. Treatment of CSR with ASV mitigates the risk. If present, CSR appears a therapeutic target for pts with CHF at risk of malignant arrhythmias.