Ventricular arrhythmia in heart failure patients with reduced ejection fraction and central sleep apnoea

Abstract

Cheyne-Stokes respiration (CSR) may trigger ventricular arrhythmia in patients with heart failure with reduced ejection fraction (HFrEF) and central sleep apnoea (CSA). This study determined the prevalence and predictors of a high nocturnal ventricular arrhythmia burden in patients with HFrEF and CSA (with and without CSR) and to evaluate the temporal association between CSR and the ventricular arrhythmia burden.This cross-sectional ancillary analysis included 239 participants from the SERVE-HF major sub-study who had HFrEF and CSA, and nocturnal ECG from polysomnography. CSR was stratified in ≥20% and <20% of total recording time (TRT). High burden of ventricular arrhythmia was defined as >30 premature ventricular complexes (PVCs) per hour of TRT. A sub-analysis was performed to evaluate the temporal association between CSR and ventricular arrhythmias in sleep stage N2.High ventricular arrhythmia burden was observed in 44% of patients. In multivariate logistic regression analysis, male sex, lower systolic blood pressure, non-use of antiarrhythmic medication and CSR ≥20% were significantly associated with PVC >30/h (odds ratio [95% confidence interval]: 5.49 [1.51–19.91], p=0.010; 0.98 [0.97–1.00], p=0.017; 5.02 [1.51–19.91], p=0.001; and 2.22 [1.22–4.05]; p=0.009; respectively). PVCs occurred more frequently during sleep phases with versus without CSR (median [interquartile range]: 64.6 [24.8–145.7] versus 34.6 [4.8–75.2]/h N2 sleep; p=0.006).Further mechanistic studies and arrhythmia analysis of major randomised trials evaluating the effect treating CSR on ventricular arrhythmia burden and arrhythmia-related outcomes are warranted to understand how these data match with the results of the parent SERVE-HF study.