European Journal of Heart Failure Advance Access originally published online on January 12, 2009
European Journal of Heart Failure 2009 11(3):273-280; doi:10.1093/eurjhf/hfn042
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Cardiac resynchronization therapy and atrial overdrive pacing for the treatment of central sleep apnoea
1 Kardiologie und Pneumologie, Georg-August-Universität, Göttingen, Germany
2 Medtronic Bakken Research Center, Maastricht, The Netherlands
3 Innere Medizin, Franziskus Krankenhaus, Linz/Rhein, Germany
4 Med. Klinik und Poliklinik II, Kardiologie und Pneumologie, Universitätsklinikum Bonn, Bonn, Germany
5 Thorax-Herz-Gefäßchirurgie, Georg-August-Universität, Göttingen, Germany
6 Fachklinik für Lungenerkrankungen, Immenhausen, Germany
* Corresponding author. Tel: +49 551 39 9650, Fax: +49 551 39 6293, Email: larsluethje{at}med.uni-goettingen.de
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Abstract |
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Aims: The combined therapeutic impact of atrial overdrive pacing (AOP) and cardiac resynchronization therapy (CRT) on central sleep apnoea (CSA) in chronic heart failure (CHF) so far has not been investigated. We aimed to evaluate the effect of CRT alone and CRT + AOP on CSA in CHF patients and to compare the influence of CRT on CHF between CSA positive and CSA negative patients.
Methods and results: Thirty patients with CRT indication underwent full night polysomnography, echocardiography, exercise testing, and neurohumoral evaluation before and 3 months after CRT implantation. In CSA positive patients (60%), two additional sleep studies were conducted after 3 months of CRT, with CRT alone or CRT + AOP, in random order. Cardiac resynchronization therapy resulted in significant improvements of NYHA class, left ventricular ejection fraction, N-terminal pro-brain natriuretic peptide, VO2max, and quality of life irrespective of the presence of CSA. Cardiac resynchronization therapy also reduced the central apnoea–hypopnoea index (AHI) (33.6 ± 14.3 vs. 23.8 ± 16.9 h–1; P < 0.01) and central apnoea index (17.3 ± 14.1 vs. 10.9 ± 13.9 h–1; P < 0.01) without altering sleep stages. Cardiac resynchronization therapy with atrial overdrive pacing resulted in a small but significant additional decrease of the central AHI (23.8 ± 16.9 vs. 21.5 ± 16.9 h–1; P < 0.01).
Conclusion: In this study, CRT significantly improved CSA without altering sleep stages. Cardiac resynchronization therapy with atrial overdrive pacing resulted in a significant but minor additional improvement of CSA. Positive effects of CRT were irrespective of the presence of CSA.
Key Words: Atrial overdrive pacing • Cardiac resynchronization therapy • Central sleep apnoea • Cheyne–Stokes respiration • Chronic heart failure
Received August 19, 2008; Revised November 9, 2008; Accepted November 20, 2008