Background Cardiac autonomic dysfunction after myocardial infarction identifies patients at high risk despite only moderately reduced left ventricular ejection fraction. We aimed to show that telemedical monitoring with implantable cardiac monitors in these patients can improve early detection of subclinical but prognostically relevant arrhythmic events. MethodsWe did a prospective investigator-initiated, randomised, multicentre, open-label, diagnostic trial at 33 centres in Germany and Austria. Survivors of acute myocardial infarction with left ventricular ejection fraction of 36-50% had biosignal analysis for assessment of cardiac autonomic function. Patients with abnormal periodic repolarisation dynamics (≥5•75 deg²) or abnormal deceleration capacity (≤2•5 ms) were randomly assigned (1:1) to telemedical monitoring with implantable cardiac monitors or conventional follow-up. Primary endpoint was time to detection of serious arrhythmic events defined by atrial fibrillation 6 min or longer, atrioventricular block class IIb or higher and fast non-sustained (>187 beats per min; ≥40 beats) or sustained ventricular tachycardia or fibrillation. This study is registered with ClinicalTrials.gov, NCT02594488.

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Sleep apnea syndromes (SAS) are highly prevalent in cardiovascular patients. Because diagnostics are cost and labor intensive, these patients often remain undiagnosed. For this reason, simple screening methods for SAS in daily clinical practice are very important. Standardized questionnaires are one way to screen patients, i.e., simple standardized questionnaires have been shown to be highly predictive in OSA, but not in CSA patients. Simple ambulatory screening devices use oxymetry and/or nasal flow to determine the apnea-hypopnea index (AHI). These devices have been shown to be highly effective in screening for OSA and CSA. In addition, algorithms that calculate the electrocardiography (ECG)-derived AHI using heart rate variability and/or QRS morphology from Holter ECG recordings are also promising. Especially the latter method could become a simple tool for cardiologists to screen for SAS in clinical routine.