Aim: Evaluation of the prevalence and nature of sleep-disordered breathing (SDB) in patients with symptomatic chronic heart failure (CHF) receiving therapy according to current guidelines. Methods and results: We prospectively screened 700 patients with CHF (NYHA class ≥ II, LV-EF ≤ 40%) for SDB using cardiorespiratory polygraphy (Embletta™). Furthermore, echocardiography, cardiopulmonary exercise and 6-min walk testing were performed. Medication included ACE-inhibitors and/or AT1-receptor blockers in at least 94%, diuretics in 87%, β-blockers in 85%, digitalis in 61% and spironolactone in 62% of patients.SDB was present in 76% of patients (40% central (CSA), 36% obstructive sleep apnoea (OSA)). CSA patients were more symptomatic (NYHA class 2.9 ± 0.5 vs. no SDB 2.57 ± 0.5 or OSA 2.57 ± 0.5; p b 0.05) and had a lower LV-EF (27.4 ± 6.6% vs. 29.3 ± 2.6%, p b 0.05) than OSA patients. Oxygen uptake (VO 2 ) was lowest in CSA patients: predicted peak VO 2 57 ± 16% vs. 64 ± 18% in OSA and 63 ± 17% in no SDB, p b 0.05. 6-min walking distances were 331 ± 111 m in CSA, 373 ± 108 m in OSA and 377 ± 118 m in no SDB (p b 0.05). Conclusions: This study confirms the high prevalence of SDB, particularly CSA in CHF patients. CSA seems to be a marker of heart failure severity.

AimsTo investigate the effects of cardiac resynchronization therapy (CRT) on survival in heart failure (HF) patients with permanent atrial fibrillation (AF) and the role of atrio-ventricular junction (AVJ) ablation in these patients.Methods and resultsData from 1285 consecutive patients implanted with CRT devices are presented: 1042 patients were in sinus rhythm (SR) and 243 (19%) in AF. Rate control in AF was achieved by either ablating the AVJ in 118 patients (AVJ-abl) or prescribing negative chronotropic drugs (AF-Drugs). Compared with SR, patients with AF were significantly older, more likely to be non-ischaemic, with higher ejection fraction, shorter QRS duration, and less often received ICD back-up. During a median follow-up of 34 months, 170/1042 patients in SR and 39/243 in AF died (mortality: 8.4 and 8.9 per 100 person-year, respectively). Adjusted hazard ratios were similar for all-cause and cardiac mortality [0.9 (0.57–1.42), P = 0.64 and 1.00 (0.60–1.66) P = 0.99, respectively]. Among AF patients, only 11/118 AVJ-abl patients died vs. 28/125 AF-Drugs patients (mortality: 4.3 and 15.2 per 100 person-year, respectively, P < 0.001). Adjusted hazard ratios of AVJ-abl vs. AF-Drugs was 0.26 [95% confidence interval (CI) 0.09–0.73, P = 0.010] for all-cause mortality, 0.31 (95% CI 0.10–0.99, P = 0.048) for cardiac mortality, and 0.15 (95% CI 0.03–0.70, P = 0.016) for HF mortality.ConclusionPatients with HF and AF treated with CRT have similar mortality compared with patients in SR. In AF, AVJ ablation in addition to CRT significantly improves overall survival compared with CRT alone, primarily by reducing HF death.

A device-based algorithm that alerts patients in case of decreasing intrathoracic impedance facilitates the detection of HF deterioration. Future randomized, controlled trials are needed to test whether the tailored use of intrathoracic impedance monitoring can improve the ambulatory management of patients with chronic HF and an implanted device.

CRT induces changes of MVO2 and MBF on a regional level with a more uniform distribution between the myocardial walls and improved ventricular efficiency in NICM. Based on the investigated parameters, CRT appears to be more effective in NICM than in ICM.

Background and aims: Sleep disordered breathing (SDB), especially Cheyne-Stokes respiration (CSR) is common in patients with chronic heart failure (CHF). Adaptive servoventilation (ASV) was recently introduced to treat CSR in CHF. The aim of this study was to investigate the effects of ASV on CSR and CHF parameters. Methods: In 29 male patients (63.9 ± 9 years, NYHA ≥ II, left ventricular ejection fraction [LV-EF] ≤ 40%), cardiorespiratory polygraphy, cardiopulmonary exercise (CPX) testing, and echocardiography were performed and concentrations of NT-proBNP determined before and after 5.8 ± 3.5 months (median 5.7 months) of ASV (AutoSet CS™2, ResMed) treatment. All patients also received guideline-driven CHF therapy. Results: Apnoea-hypopnoea-index was reduced from 37.4 ± 9.4/h to 3.9 ± 4.1/h (p b 0.001). Workload during CPX testing increased from 81 ± 26 to 100 ± 31 W (p = 0.005), oxygen uptake (VO 2 ) at the anaerobic threshold from 12.6 ± 3 to 15.3 ± 4 ml/kg/min (p = 0.01) and predicted peak VO 2 from 58 ± 12% to 69 ± 17% (p = 0.007). LV-EF increased from 28.2 ± 7% to 35.2 ± 11% (p = 0.001), and NT-proBNP levels decreased significantly (2285 ± 2192 pg/ml to 1061 ± 1293 pg/ml, p = 0.01). Conclusions: In selected patients with CHF and CSR, addition of ASV to standard heart failure therapy is able to improve SDB, CPX test results, LV-EF and NT-proBNP concentrations.