Effect of Sleep-Disordered Breathing on Appropriate Implantable Cardioverter-Defibrillator Therapy in Patients With Heart Failure

Kwon, Younghoon; Koene, Ryan J.; Kwon, Osung; Kealhofer, Jessica V.; Adabag, Selçuk; Duval, Sue

doi:10.1161/circep.116.004609

Cited by 26 publications

(19 citation statements)

References 56 publications

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“…A meta-analysis showed a 55% increased incidence of appropriate ICD therapies in heart failure patients with sleep disordered breathing (both central and obstructive sleep apnea) compared with patients without sleep disordered breathing. 35 Interesting temporal climatic temperature trends in the incidence of electrical storm was reported from the TEMPEST multicenter study (Trial to Evaluate the Management of Paroxysmal Supraventricular Tachycardia During Electrophysiologic Study With Tecad-enoson) of patients with ICD. 36 Electrical storm was more likely to occur during working days, early in the morning between 8 and 10 am, and during months that register an increased temperature variation compared with the previous month.…”

Section: Implantable Cardioverter Defibrillatormentioning

confidence: 99%

Year in Review in Cardiac Electrophysiology

Tzou

Hussein

Madhavan

et al. 2018

Circ: Arrhythmia and Electrophysiology

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1 In the past year, there have been key advances in our understanding of arrhythmia mechanisms and diagnosis and important new therapies. We have seen advances in basic cardiac electrophysiology with demonstration of optogenetic targeting of atrial fibrillation (AF) rotors, induced pluripotent stem cell-based biological pacemakers, small-conductance Ca 2+ -activated K + (SK) channels as targets for AF treatment, and reductions in inward rectifier potassium current in promoting ventricular fibrillation. Hand-held ECG devices and implantable loop recorders have been shown to detect subclinical AF. Catheter ablation of AF in patients with left ventricular dysfunction improves outcomes compared with medical therapy. Both hybrid thoracoscopic surgical and catheter ablation procedures and off-pump surgery for AF have demonstrated efficacy. Anticoagulation with uninterrupted dabigatran had a lower major bleeding rate compared with uninterrupted warfarin after AF ablation. Studies have examined optimizing access to automatic external defibrillators by identifying optimal locations for placement and possibility of using a drone delivery network. In long-QT syndrome, there are advances in understanding of ECG predictors of arrhythmic events, the role of the role of gene variants in conferring arrhythmic risk, and effect of age and sex on QTc interval. There are numerous advances in the treatment of ventricular tachycardia, including noninvasive cardiac radiation. Catheter ablation and implantable devices continue to demonstrate effectiveness in patients with congenital heart disease.In the past year, there have been numerous ground-breaking discoveries and observations that illustrate the vibrancy and promise of our field. In this review, we have tried to capture articles published in the year 2017 of particular interest to cardiac electrophysiologists. Although we have focused on articles from our journal, we have captured many of the most impactful articles in numerous other journals. We apologize for omitting a large number of other important articles that cannot be included in this review because of space limitations. We have placed some of these in our Data Supplement. BASIC ELECTROPHYSIOLOGY BradyarrhythmiasThe search for new biological therapies for bradycardia met with recent progress as human keratinocytes genetically reprogrammed into electrically unstable cardiomyocytes were shown to persist and provide continued catecholaminergic-responsive pacing for 13 weeks after subepicardial injection into immunosuppressed dogs at the time of atrioventricular (AV) node ablation.1 Although only 40% to 80% of the beats matched the site of cell injection, this is first study to test a human induced pluripotent stem cell-based biological pacemaker in a large animal model of heart block and represents an important step forward in biological pacing.

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Section: Implantable Cardioverter Defibrillatormentioning

confidence: 99%

Year in Review in Cardiac Electrophysiology

Tzou

Hussein

Madhavan

et al. 2018

Circ: Arrhythmia and Electrophysiology

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“…48 In a recent meta-analysis, the risk of appropriate implantable-defibrillator therapy was estimated to be 55% greater in patients with SDB than in those without SDB, with similar augmentation in those with OSA or CSA. 49 …”

Section: Prevalencementioning

confidence: 99%

Sleep-Disordered Breathing in Heart Failure　― A Therapeutic Dilemma ―

Haruki

Floras

2017

Circ J

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for their deployment can be advocated (Table). However, the promise of observational studies and randomized trials of small size and duration describing a beneficial effect of treating SDB in HF via positive airway pressure (PAP) was not realized in 2 recent randomized outcome-driven trials: SAVE, which evaluated the cardiovascular effect of treating OSA in a cohort without HF, 7 and SERVE-HF, which reported the results of a strategy of random allocation of minute-ventilation-triggered adaptive servo-ventilation (ASV) for HF patients with CSA. 3 Consequently, equipoise remains as to whether either OSA or CSA, once detected in a HF patient with reduced left ventricular ejection fraction (LVEF), should be therapeutically suppressed. The threefold purpose of this review was to: (1) summarize current knowledge concerning the prevalence, pathophysiology, and prognostic implications of SDB in HF in support of treatment; (2) examine and reflect upon the results of randomized controlled trials evaluating the effect of treating OSA or CSA on cardiovascular endpoints and mortality; and (3) illustrate how ADVENT-HF, a randomized controlled trial designed to determine the effect of treating HF patients with either CSA or nonsleepy OSA using a peak-airflow triggered ASV algorithm, could resolve the present clinical equipoise concerning the treatment of one or both forms of SDB.A fundamental and as yet unresolved question for the heart failure (HF) community is whether coexisting obstructive (OSA) or central sleep apnea (CSA) should be specific targets of therapy. For individuals without HF, the principal clinical indication to treat sleep apnea is to improve quality of life (QOL) and avert accidental injury or death by alleviating daytime hypersomnolence. However, this indication does not pertain to the majority of patients with reduced left ventricular systolic function and sleep-disordered breathing (SDB) as they are not burdened by excess daytime sleepiness. 1-3 In such individuals, the impetus to diagnosis and treatment is the hypothesis that attenuation or abolition of SDB will modify beneficially the natural history of HF.OSA and CSA interrupt breathing by different mechanisms but impose qualitatively similar autonomic, chemical, mechanical, and inflammatory burdens on the heart and circulation. 4-6 Because contemporary evidence-based drug and device HF therapies have little or no mitigating effect on the acute consequences of such stimuli or on the long-term structural and functional adaptations they induce within the atria and ventricles, the brain and the peripheral vasculature, there is a sound mechanistic rationale for targeting SDB to reduce cardiovascular event rates and prolong life. Importantly, effective treatment is presently available for both OSA and CSA and cogent reasons Sleep-disordered breathing (SDB) occurs in approximately 50% of patients with reduced left ventricular ejection fraction receiving contemporary heart failure (HF) therapies. Obstructive (OSA) and central sleep apneas (CSA) interrupt brea...

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“…1,3,4 Over the past several decades, more evidence of pathophysiology of AF is found but is not entirely understood. 7 Recently, accumulated evidence of sleep disorders and their association with arrhythmia is reported, 8,9 especially obstructive sleep apnoea (OSA). Extrinsic factors, such as the autonomic nervous system, often are involved, as well.…”

Section: Introductionmentioning

confidence: 99%

“…Cardiac rhythm during sleep is influenced by the autonomic nervous system and various pathological states. 7 Recently, accumulated evidence of sleep disorders and their association with arrhythmia is reported, 8,9 especially obstructive sleep apnoea (OSA). 10,11 Much research ranging from basic science to clinical studies found that treatment of OSA could decrease recurrence or prevent incident AF.…”

Section: Introductionmentioning

confidence: 99%