Association Between Device-Detected Sleep-Disordered Breathing and Implantable Defibrillator Therapy in Patients With Heart Failure.

Autor:	Mazza A; Cardiology Division, Santa Maria della Stella Hospital, Orvieto, Italy., Bendini MG; Cardiology Division, Santa Maria della Stella Hospital, Orvieto, Italy., Bianchi V; Unità Operativa di Elettrofisiologia, Studio e Terapia deli Aritmie,' Monaldi Hospital, Naples, Italy., Esposito C; Ospedali Riuniti San Giovanni di Dio Ruggi d'Aragona, Salerno, Italy., Calò L; Policlinico Casilino, Rome, Italy., Andreoli C; San Giovanni Battista Hospital, Foligno, Italy., Santobuono VE; University of Bari, Policlinico di Bari, Bari, Italy., Dello Russo A; Clinica di Cardiologia e Aritmologia, Università Politecnica delle Marche, 'Ospedali Riuniti,' Ancona, Italy., Viscusi M; Sant' Anna e San Sebastiano Hospital, Caserta, Italy., La Greca C; Fondazione Poliambulanza, Brescia, Italy., Baiocchi C; Azienda Ospedaliera Universitaria Senese, Siena, Italy., Talarico A; Ospedale SS. Annunziata, Cosenza, Italy., Albanese R; Ospedale Del Mare, ASL NA1, Naples, Italy., Arena G; Ospedale Civile Apuane, Massa, Italy., Giubilato G; 'F. Spaziani' Hospital, Frosinone, Italy., Ziacchi M; Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Polyclinic Sant'Orsola-Malpighi, Bologna, Italy., Rapacciuolo A; olyclinic Federico II, Naples, Italy., Campari M; Policlinico Casilino, Rome, Italy., Valsecchi S; Boston Scientific, Milan, Italy., Boriani G; Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy. Electronic address: giuseppe.boriani@unimore.it.
Jazyk:	angličtina
Zdroj:	JACC. Clinical electrophysiology [JACC Clin Electrophysiol] 2022 Oct; Vol. 8 (10), pp. 1249-1256. Date of Electronic Publication: 2022 Sep 28.
DOI:	10.1016/j.jacep.2022.07.017
Abstrakt:	Background: Sleep-disordered breathing is highly prevalent in heart failure (HF) and has been suggested as a risk factor for malignant ventricular arrhythmias. The Respiratory Disturbance Index (RDI) computed by an implantable cardioverter-defibrillator (ICD) algorithm accurately identifies severe sleep apnea. Objectives: In the present analysis, the authors evaluated the association between ICD-detected sleep apnea and the incidence of appropriate ICD therapies in patients with HF. Methods: We enrolled 411 HF patients who had received an ICD endowed with an algorithm that calculates the RDI each night. In this analysis, the weekly mean RDI value was considered. The endpoint was the first appropriate ICD shock. Results: The median follow-up was 26 months (25th to 75th percentile: 16-35 months). During follow-up, 1 or more ICD shocks were documented in 58 (14%) patients. Patients with shocks were younger (age 66 ± 13 years vs 70 ± 10 years; P = 0.038), and had more frequently undergone implantation for secondary prevention (21% vs 10%; P = 0.026). The maximum RDI value calculated during the entire follow-up period did not differ between patients with and without shocks (55 ± 15 episodes/h vs 54 ± 14 episodes/h; P = 0.539). However, the ICD-detected RDI showed considerable variability during follow-up. The overall median of the weekly RDI was 33 episodes/h (25th to 75th percentile: 24-45 episodes/h). A time-dependent Cox regression model revealed that a continuously measured weekly mean RDI of ≥45 episodes/h was independently associated with shock occurrence (HR: 4.63; 95% CI: 2.54-8.43; P < 0.001), after correction for baseline confounders (age, secondary prevention). Conclusions: In HF patients, appropriate ICD shocks were more likely to be delivered during periods when patients exhibited more sleep-disordered breathing. (Arrhythmias Detection in a Real World Population [RHYTHM DETECT]; NCT02275637). Competing Interests: Funding Support and Author Disclosures Drs Campari and Valsecchi are employees of Boston Scientific, Inc. Dr Boriani has received small speaker fees from Boston, Biotronik, and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. (Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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