Sleep-disordered breathing and inappropriate defibrillator shocks in chronic heart failure.

Abstract

PURPOSE:

Supraventricular tachyarrhythmias are a major cause of inappropriate defibrillator shocks. Sleep-disordered breathing (SDB) is a known risk factor for atrial fibrillation (AF). We hypothesized that Cheyne-Stokes respiration (CSA) and obstructive sleep apnea (OSA) have an impact on inappropriate defibrillator discharges in patients witch chronic heart failure (CHF) and cardiac resynchronization therapy with defibrillator (CRT-D).

METHODS:

In this study, 172 patients with CHF (LVEF ≤ 45 %, NYHA-class ≥ 2) and CRT-D underwent overnight polygraphy; 54 had no SDB (apnea-hypopnea index < 5/h), 59 had OSA, and 59 had CSA. During follow-up (36 months), inappropriate defibrillator shocks were documented.

RESULTS:

In all, 17 patients had inappropriate defibrillator shocks (9.9 %; eight oversensing due to lead fractures, five caused by atrial fibrillation, four because of sinus tachycardia). Mean event-free survival time was 33.5 ± 1.2 months in the CSA group, 35.2 ± 0.7 months in the OSA group, and 32.1 ± 1.5 months in the no SDB group, respectively (CSA vs. no SDB p = 0.63; OSA vs. no SDB p = 0.31; CSA vs. OSA p = 0.45). Stepwise Cox proportional hazard regression analysis revealed an independent association for age (per year: hazard ratio 0.90, 95 % confidence interval 0.85-0.96, p < 0.001), but not for any kind of SDB.

CONCLUSIONS:

SDB was not associated with inappropriate defibrillator shocks. We assume this is due to the low incidenceand low proportion of inappropriate therapies in response to AF.

• Authors: Thomas Bitter, Klaus-Jürgen Gutleben, Georg Nölker, Zisis Dimitriadis, Christian Prinz, Jürgen Vogt, Dieter Horstkotte, Olaf Oldenburg
• Journal: Herzschrittmachertherapie & Elektrophysiologie (Herzschrittmacherther Elektrophysiol) Vol. 25 Issue 3 Pg. 198-205 (Sep 2014) ISSN: 1435-1544 [Electronic] Germany
• PMID: 25070930 (Publication Type: Clinical Trial, Journal Article)

Topics

• Aged
• Causality
• Comorbidity
• Defibrillators, Implantable (statistics & numerical data)
• Electric Injuries (mortality)
• Equipment Failure (statistics & numerical data)
• Female
• Germany (epidemiology)
• Heart Failure (mortality, prevention & control)
• Humans
• Incidence
• Male
• Middle Aged
• Registries
• Risk Factors
• Sleep Apnea Syndromes (mortality)
• Survival Rate