title: Usefulness of sleep-disordered breathing to predict occurrence of appropriate and inappropriate implantable-cardioverter defibrillator therapy in patients with implantable cardioverter-defibrillator for primary prevention of sudden cardiac death.
abstract: Advanced heart failure (HF) is associated with severe sleep-disordered breathing (SDB). In addition, most patients with HF are treated with an implantable cardioverter-defibrillator (ICD) for primary prevention of sudden cardiac death. The incidence of ICD therapy in such a patient cohort with SDB has never been investigated. The present study sought to determine the effect of SDB on the incidence of appropriate and inappropriate ICD therapy in patients with a categorical primary prevention ICD indication. A total of 133 consecutive ICD patients with New York Heart Association class II-III HF and depressed left ventricular function (≤35%) with no history of ventricular arrhythmia underwent a sleep study before ICD implantation and were followed for 24 ± 8 months, prospectively. A relevant SDB was defined as an apnea-hypopnea index of ≥10 events/hour. Of these 133 patients, 82 (62%) had SDB. Overweight (body mass index >29.1 vs 24.7 kg/m(2); p <0.001) was identified as the only independent risk factor for SDB. Appropriate ICD therapy intervention was significantly greater among patients with SDB than among patients without SDB (54% vs 34%, p = 0.03). Inappropriate ICD therapy intervention was documented more often in patients with SDB (n = 24 [29%] vs 7 [14%]; p = 0.04). An apnea-hypopnea index >10 events/hour was an independent predictor of appropriate ICD therapy on multivariate analysis (odds ratio 2.5, 95% confidence interval 1.8 to 4.04; p = 0.01). In conclusion, the present study is the first trial exploring the effect of SDB on the incidence of appropriate and inappropriate ICD therapy in patients with HF with a primary prevention indication. These results indicate that a preimplantation sleep study will identify patients with HF prone to receive appropriate and inappropriate ICD therapy.
authors: Department of Medicine, Cardiology/Pneumology, University Hospital Bonn, Bonn, Germany. jens.kreuz@ukb.uni-bonn.de
authors: Jens
authors: J
authors: Kreuz
authors: Dirk
authors: D
authors: Skowasch
authors: Fritz
authors: F
authors: Horlbeck
authors: Carolin
authors: C
authors: Atzinger
authors: Jan W
authors: JW
authors: Schrickel
authors: Henning
authors: H
authors: Lorenzen
authors: Georg
authors: G
authors: Nickenig
authors: Jörg O
authors: JO
authors: Schwab
mesh_terms: D001145:Arrhythmias, Cardiac / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D011322:Primary Prevention / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012891:Sleep Apnea Syndromes / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D013318:Stroke Volume; D016896:Treatment Outcome; D016277:Ventricular Function, Left