Ventricular arrhythmia, Cheyne-Stokes respiration, and death: observations from patients with defibrillators.
OBJECTIVE
To determine whether ventricular arrhythmia related to nocturnal hypoxaemia during Cheyne-Stokes respiration (CSR) explains the observation that CSR is an independent marker of death in heart failure.


METHODS
Prospective, observational study.


METHODS
101 patients at high risk of clinical serious ventricular arrhythmia fitted with an implantable cardioverter-defibrillator (ICD).


METHODS
Patients were studied at baseline for CSR during sleep. Arrhythmia requiring device discharge was used as a surrogate marker for possible sudden cardiac death.


RESULTS
101 patients (42 with CSR) were followed up for a total of 620 months. Twenty six patients experienced 432 ICD discharge episodes. Twenty four (6%), 210 (49%), 125 (29%), and 73 (17%) episodes occurred across the time quartiles 0000-0559, 0600-1159, 1200-1759, and 1800-2359, respectively. Kaplan-Meier analysis showed a relative risk of 1 (95% confidence interval 0.5 to 2.2, p = 1) for device discharge in the CSR group. The average (SED) numbers of nocturnal ICD discharges per patient per month of follow up were 0.01 (0.01) and 0.04 (0.02) for patients with and without CSR, respectively (p = 0.6).


CONCLUSIONS
These findings refute the proposition that CSR is related to heart failure death through nocturnal serious ventricular arrhythmia.
Staniforth
A D
AD
Department of Cardiovascular Medicine, Queens Medical Centre, Nottingham NG7 2UH, UK. adstaniforth@beeb.net
Sporton
S C
SC
Early
M J
MJ
Wedzicha
J A
JA
Nathan
A W
AW
Schilling
R J
RJ
D000368:Aged; D001145:Arrhythmias, Cardiac / Q000097:blood / Q000209:etiology* / Q000628:therapy; D002639:Cheyne-Stokes Respiration / Q000097:blood / Q000150:complications*; D016757:Death, Sudden, Cardiac / Q000209:etiology*; D017147:Defibrillators, Implantable; D018572:Disease-Free Survival; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000150:complications*; D006801:Humans; D008297:Male; D010092:Oximetry / Q000379:methods; D010100:Oxygen / Q000097:blood; D017286:Polysomnography / Q000379:methods; D011446:Prospective Studies; D020181:Sleep Apnea, Obstructive / Q000097:blood / Q000150:complications
D010100:Oxygen