Pneumologie 2012; 66 - P87
DOI: 10.1055/s-0032-1302680

Sleep disordered breathing identified as a significant risk factor for malignant ventricular arrhythmias in a collective with implantable cardioverter defibrillator for primary prevention of sudden cardiac death

J Kreuz 1, D Skowasch 1, C Atzinger 1, G Nickenig 1, J Schwab 1
  • 1University of Bonn, Deparment of Medicine, Cardiology

Background:

Sleep-disordered breathing (SDB) poses a relevant risk factor for malignant ventricular arrhythmias in patients suffering from heart failure equipped with an implantable cardioverter defibrillator (ICD). This study seeks to determine the impact of SDB on the incidence of these arrhythmias in a collective of patients with categorical primary prevention ICD indication.

Methods:

123 consecutive ICD patients with NYHA II-III heart failure and depressed left ventricular function (EF≤35%) with no history of malignant ventricular arrhythmias underwent a pre-implantation ambulatory sleep study and were prospectively followed for 23±8 months. SDB was defined as an apnea-hypopnea index (AHI) ≥10 events/h.

Results:

76 patients (62%) suffered from relevant SDB (AHI ≥10/h). Overweight (body mass index >29.1 vs. 24.7p<0.001) was identified as the only independent risk factor for SDB. Ventricular arrhythmias occurred in 41 patients suffering from SDB (54% of this collective), whereas the incidence was significantly lower in patients without SDB (n=47; 16 patients with arrhythmias=34%; p=0.02). An AHI >10/h represents the only independent predictor of malignant ventricular arrhythmias in this primary prevention collective (Odds Ratio 2.5; 95% Confidence Interval 1.8–4.04; p=0.01).

Discussion:

This study is the first trial exploring the impact of SDB on the incidence of malignant tachyarrhythmias in a solely primary prevention collective. The results indicate the value of a pre-implantation sleep study in any primary prevention ICD recipient and its potential role in risk stratification. Further studies which investigate the potential “arrhythmia-reduction” of a continuous positive airway pressure therapy are mandatory.

Key words:

Implantable Cardioverter Defibrillator, primary prevention, sleep disordered breathing, ventricular arrhythmias.