Atrial overdrive pacing in patients with sleep apnea with implanted pacemaker.
BACKGROUND
Atrial overdrive pacing markedly improved sleep-disordered breathing in a recent study.


OBJECTIVE
Using a single-blind, randomized, crossover design, we aimed to reproduce these findings and investigate the possible underlying mechanisms.


METHODS
Twenty ambulatory patients with an implanted pacemaker or cardioverter defibrillator were studied by polysomnography on 3 consecutive nights in a randomized, single-blind, crossover study in which devices were programmed for nonpacing or for overdrive pacing at 7 or 15 beats/minute faster than the mean nocturnal heart rate. Ventilation and biomarkers (urinary norepinephrine excretion, amino-terminal portion of the precursor of brain natriuretic peptide, or NT-proBNP, were also evaluated.


RESULTS
Neither the primary endpoint apnea-hypopnea index, nor the apnea index, oxygen desaturation, ventilation, or biomarkers were affected by the nocturnal atrial overdrive pacing. A small, clinically insignificant, rate-dependent reduction in the hypopnea index was evoked by pacing (nonpacing, 13.4 +/- 1.4; pacing 7, 12.9 +/- 1.4; pacing 15, 10.9 +/- 1.0; p < 0.01, analysis of variance).


CONCLUSIONS
The lack of effect on the apnea-hypopnea index means that atrial overdrive pacing is inappropriate for treating sleep-disordered breathing.
Lüthje
Lars
L
Herzzentrum Göttingen, Abteilung Kardiologie und Pneumologie, Georg-August-Universität Göttingen, Robert-Koch-Strasse 40, 37075 Göttingen, Germany.
Unterberg-Buchwald
Christina
C
Dajani
Dani
D
Vollmann
Dirk
D
Hasenfuss
Gerd
G
Andreas
Stefan
S
D000368:Aged; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D017286:Polysomnography; D016037:Single-Blind Method; D012891:Sleep Apnea Syndromes / Q000628:therapy*