Ventricular arrhythmia in heart failure patients with reduced ejection fraction and central sleep apnoea
- Christoph Fisser1⇑,
- Jannis Bureck1,
- Lara Gall1,
- Victoria Vaas1,
- Jörg Priefert1,
- Sabine Fredersdorf1,
- Florian Zeman2,
- Dominik Linz3,4,5,6,
- Holger Woehrle7,
- Renaud Tamisier8,
- Helmut Teschler9,
- Martin R. Cowie10 and
- Michael Arzt1
- 1Department of Internal Medicine II, University Medical Centre Regensburg, Regensburg, Germany
- 2Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
- 3Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
- 4Department of Cardiology, Radboud University Medical Centre, Nijmegen, the Netherlands
- 5Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- 6Centre for Heart Rhythm Disorders, Royal Adelaide Hospital, University of Adelaide, Adelaide, Australia
- 7Sleep and Ventilation Center Blaubeuren, Lung Center Ulm, Ulm, Germany
- 8HP2 Laboratory, INSERM U1042, Grenoble Alpes University, Sleep laboratory, Pole Thorax et Vaisseaux, Grenoble Alps University Hospital, Grenoble, France
- 9Department of Pneumology, AFPR, Ruhrlandklinik, West German Lung Center, University Medicine Essen, Essen, Germany
- 10Faculty of Medicine, National Heart & Lung Institute, Imperial College London, London, United Kingdom
- Christoph Fisser (christoph.fisser{at}ukr.de)
Abstract
Cheyne-Stokes respiration (CSR) may trigger ventricular arrhythmia in patients with heart failure with reduced ejection fraction (HFrEF) and central sleep apnoea (CSA). This study determined the prevalence and predictors of a high nocturnal ventricular arrhythmia burden in patients with HFrEF and CSA (with and without CSR) and to evaluate the temporal association between CSR and the ventricular arrhythmia burden.
This cross-sectional ancillary analysis included 239 participants from the SERVE-HF major sub-study who had HFrEF and CSA, and nocturnal ECG from polysomnography. CSR was stratified in ≥20% and <20% of total recording time (TRT). High burden of ventricular arrhythmia was defined as >30 premature ventricular complexes (PVCs) per hour of TRT. A sub-analysis was performed to evaluate the temporal association between CSR and ventricular arrhythmias in sleep stage N2.
High ventricular arrhythmia burden was observed in 44% of patients. In multivariate logistic regression analysis, male sex, lower systolic blood pressure, non-use of antiarrhythmic medication and CSR ≥20% were significantly associated with PVC >30/h (odds ratio [95% confidence interval]: 5.49 [1.51–19.91], p=0.010; 0.98 [0.97–1.00], p=0.017; 5.02 [1.51–19.91], p=0.001; and 2.22 [1.22–4.05]; p=0.009; respectively). PVCs occurred more frequently during sleep phases with versus without CSR (median [interquartile range]: 64.6 [24.8–145.7] versus 34.6 [4.8–75.2]/h N2 sleep; p=0.006).
Further mechanistic studies and arrhythmia analysis of major randomised trials evaluating the effect treating CSR on ventricular arrhythmia burden and arrhythmia-related outcomes are warranted to understand how these data match with the results of the parent SERVE-HF study.
Footnotes
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Conflict of interest: Dr. Fisser reports grants from German Heart Foundation/German Foundation of Heart Research, during the conduct of the study.
Conflict of interest: Dr. Bureck has nothing to disclose.
Conflict of interest: Dr. Gall has nothing to disclose.
Conflict of interest: Dr. Vaas reports grants from German Society of Sleep Medicine, outside the submitted work.
Conflict of interest: Dr. Priefert has nothing to disclose.
Conflict of interest: Dr. Fredersdorf has nothing to disclose.
Conflict of interest: Dr. Zeman has nothing to disclose.
Conflict of interest: Dr. Linz reports personal fees from Bayer, personal fees from LivaNova, personal fees from ResMed, personal fees from Respicardia, outside the submitted work.
Conflict of interest: Dr. Wöhrle reports other from ResMed, outside the submitted work.
Conflict of interest: Dr. Tamisier reports grants from ResMed, personal fees from Agiradom, outside the submitted work.
Conflict of interest: Dr. Teschler reports grants and personal fees from ResMed, outside the submitted work.
Conflict of interest: Dr. Cowie reports grants and personal fees from ResMed, personal fees from Respicardia, grants from Bayer, outside the submitted work.
Conflict of interest: Dr. Arzt reports grants from ResMed, during the conduct of the study; personal fees from ResMed, grants and personal fees from Philips Respironics, personal fees from Boehringer-Ingelheim, personal fees from NRI, personal fees from Novartis, personal fees from JAZZ pharmaceuticals, personal fees from Inspire, personal fees from Bresotec, grants from Else-Kroehner Fresenius Foundation, outside the submitted work.
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- Received March 5, 2021.
- Accepted May 18, 2021.
- Copyright ©The authors 2021
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