Adaptive servo-ventilation reduces atrial fibrillation burden in patients with heart failure and sleep apnea

Jonathan P. Piccini, Sean D. Pokorney, Kevin J. Anstrom, Olaf Oldenburg, Naresh M Punjabi, Mona Fiuzat, Gudaye Tasissa, David J. Whellan, Jo Ann Lindenfeld, Adam Benjafield, Holger Woehrle, Amy Blase, Christopher M. O'Connor

Research output: Contribution to journalArticle

Abstract

Background: Patients with heart failure and sleep apnea are at increased risk for developing arrhythmias. Whether treatment of sleep apnea reduces arrhythmias is unknown. Objective: The purpose of this study was to determine whether adaptive servo-ventilation (ASV) with optimal medical therapy (OMT) reduces atrial fibrillation (AF) and/or ventricular tachycardia/ventricular fibrillation (VT/VF) burden compared to OMT alone. Methods: We conducted a prospective substudy of patients with pacemakers/defibrillators in the Cardiovascular Improvements with Minute Ventilation-Targeted ASV Therapy in Heart Failure (CAT-HF) trial. Change in arrhythmia burden was compared using a mixed model analysis to account for multiple measurements per patient. Results: Among 35 randomized patients eligible and analyzed (19 ASV, 16 OMT only) in the AF cohort, mean age was 64 ± 12 years, 23% were women (n = 8), 49% had previous AF (n = 17), 89% had reduced ejection fraction (n = 31), and mean apnea hypopnea index was 41 ± 17 events per hour. Baseline characteristics were similar between groups. Change in AF burden from baseline to follow-up was –15.8% ± 36.5% with ASV vs +23.7% ± 36.2% with OMT (P =.034). There was no significant change in the AF cohort in the mean number of VT/VF events: +3.3 ± 14.9 events with ASV vs –0.3 ± 7.3 events with OMT (P =.58). Five subjects had appropriate therapies for VT/VF in the ASV arm vs 6 subjects in the OMT arm. Conclusion: This study provides proof of concept that treatment of sleep apnea with ASV leads to reduction in AF burden compared with OMT alone, without an increase in VT/VF events. This hypothesis should be tested in a large outcomes trial.

Original languageEnglish (US)
Pages (from-to)91-97
Number of pages7
JournalHeart Rhythm
Volume16
Issue number1
DOIs
StatePublished - Jan 1 2019

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Sleep Apnea Syndromes
Atrial Fibrillation
Ventilation
Heart Failure
Ventricular Fibrillation
Ventricular Tachycardia
Therapeutics
Cardiac Arrhythmias
Defibrillators
Apnea

Keywords

  • Arrhythmia
  • Atrial fibrillation
  • Cardiac implanted electronic device
  • Heart failure
  • Randomized clinical trial
  • Sleep apnea

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Piccini, J. P., Pokorney, S. D., Anstrom, K. J., Oldenburg, O., Punjabi, N. M., Fiuzat, M., ... O'Connor, C. M. (2019). Adaptive servo-ventilation reduces atrial fibrillation burden in patients with heart failure and sleep apnea. Heart Rhythm, 16(1), 91-97. https://doi.org/10.1016/j.hrthm.2018.07.027

Adaptive servo-ventilation reduces atrial fibrillation burden in patients with heart failure and sleep apnea. / Piccini, Jonathan P.; Pokorney, Sean D.; Anstrom, Kevin J.; Oldenburg, Olaf; Punjabi, Naresh M; Fiuzat, Mona; Tasissa, Gudaye; Whellan, David J.; Lindenfeld, Jo Ann; Benjafield, Adam; Woehrle, Holger; Blase, Amy; O'Connor, Christopher M.

In: Heart Rhythm, Vol. 16, No. 1, 01.01.2019, p. 91-97.

Research output: Contribution to journalArticle

Piccini, JP, Pokorney, SD, Anstrom, KJ, Oldenburg, O, Punjabi, NM, Fiuzat, M, Tasissa, G, Whellan, DJ, Lindenfeld, JA, Benjafield, A, Woehrle, H, Blase, A & O'Connor, CM 2019, 'Adaptive servo-ventilation reduces atrial fibrillation burden in patients with heart failure and sleep apnea' Heart Rhythm, vol. 16, no. 1, pp. 91-97. https://doi.org/10.1016/j.hrthm.2018.07.027
Piccini, Jonathan P. ; Pokorney, Sean D. ; Anstrom, Kevin J. ; Oldenburg, Olaf ; Punjabi, Naresh M ; Fiuzat, Mona ; Tasissa, Gudaye ; Whellan, David J. ; Lindenfeld, Jo Ann ; Benjafield, Adam ; Woehrle, Holger ; Blase, Amy ; O'Connor, Christopher M. / Adaptive servo-ventilation reduces atrial fibrillation burden in patients with heart failure and sleep apnea. In: Heart Rhythm. 2019 ; Vol. 16, No. 1. pp. 91-97.
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abstract = "Background: Patients with heart failure and sleep apnea are at increased risk for developing arrhythmias. Whether treatment of sleep apnea reduces arrhythmias is unknown. Objective: The purpose of this study was to determine whether adaptive servo-ventilation (ASV) with optimal medical therapy (OMT) reduces atrial fibrillation (AF) and/or ventricular tachycardia/ventricular fibrillation (VT/VF) burden compared to OMT alone. Methods: We conducted a prospective substudy of patients with pacemakers/defibrillators in the Cardiovascular Improvements with Minute Ventilation-Targeted ASV Therapy in Heart Failure (CAT-HF) trial. Change in arrhythmia burden was compared using a mixed model analysis to account for multiple measurements per patient. Results: Among 35 randomized patients eligible and analyzed (19 ASV, 16 OMT only) in the AF cohort, mean age was 64 ± 12 years, 23{\%} were women (n = 8), 49{\%} had previous AF (n = 17), 89{\%} had reduced ejection fraction (n = 31), and mean apnea hypopnea index was 41 ± 17 events per hour. Baseline characteristics were similar between groups. Change in AF burden from baseline to follow-up was –15.8{\%} ± 36.5{\%} with ASV vs +23.7{\%} ± 36.2{\%} with OMT (P =.034). There was no significant change in the AF cohort in the mean number of VT/VF events: +3.3 ± 14.9 events with ASV vs –0.3 ± 7.3 events with OMT (P =.58). Five subjects had appropriate therapies for VT/VF in the ASV arm vs 6 subjects in the OMT arm. Conclusion: This study provides proof of concept that treatment of sleep apnea with ASV leads to reduction in AF burden compared with OMT alone, without an increase in VT/VF events. This hypothesis should be tested in a large outcomes trial.",
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AU - Pokorney, Sean D.

AU - Anstrom, Kevin J.

AU - Oldenburg, Olaf

AU - Punjabi, Naresh M

AU - Fiuzat, Mona

AU - Tasissa, Gudaye

AU - Whellan, David J.

AU - Lindenfeld, Jo Ann

AU - Benjafield, Adam

AU - Woehrle, Holger

AU - Blase, Amy

AU - O'Connor, Christopher M.

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