Cardiac resynchronization therapy and atrial overdrive pacing for the treatment of central sleep apnoea.
OBJECTIVE
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.


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, VO(2)max, 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).


CONCLUSIONS
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.
Lüthje
Lars
L
Kardiologie und Pneumologie, Georg-August-Universität, Göttingen, Germany. larsluethje@med.uni-goettingen.de
Renner
Bernd
B
Kessels
Roger
R
Vollmann
Dirk
D
Raupach
Tobias
T
Gerritse
Bart
B
Tasci
Selcuk
S
Schwab
Jörg O
JO
Zabel
Markus
M
Zenker
Dieter
D
Schott
Peter
P
Hasenfuss
Gerd
G
Unterberg-Buchwald
Christina
C
Andreas
Stefan
S
D000368:Aged; D016275:Atrial Function / Q000502:physiology; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000503:physiopathology*; D006333:Heart Failure / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D008297:Male; D017286:Polysomnography; D016037:Single-Blind Method; D020182:Sleep Apnea, Central / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome