Effects of Adaptive Servo-Ventilation on Nocturnal Ventricular Arrhythmia in Heart Failure Patients With Reduced Ejection Fraction and Central Sleep Apnea–An Analysis From the SERVE-HF Major Substudy

Abstract

BackgroundThe SERVE-HF trial investigated the effect of treating central sleep apnoea (CSA) with adaptive servo-ventilation (ASV) in patients with heart failure with reduced ejection fraction (HFrEF).ObjectiveThe aim of the present ancillary analysis of the SERVE-HF major substudy (NCT01164592) was to assess the effects of ASV on the burden of nocturnal ventricular arrhythmias as one possible mechanism for sudden cardiac death in ASV-treated patients with HFrEF and CSA.MethodsThree hundred twelve patients were randomized in the SERVE-HF major substudy [no treatment of CSA (control) vs. ASV]. Polysomnography including nocturnal ECG fulfilling technical requirements was performed at baseline, and at 3 and 12 months. Premature ventricular complexes (events/h of total recording time) and non-sustained ventricular tachycardia were assessed. Linear mixed models and generalized linear mixed models were used to analyse differences between the control and ASV groups, and changes over time.ResultsFrom baseline to 3- and 12-month follow-up, respectively, the number of premature ventricular complexes (control: median 19.7, 19.0 and 19.0; ASV: 29.1, 29.0 and 26.0 events/h; p = 0.800) and the occurrence of ≥1 non-sustained ventricular tachycardia/night (control: 18, 25, and 18% of patients; ASV: 24, 16, and 24% of patients; p = 0.095) were similar in the control and ASV groups.ConclusionAddition of ASV to guideline-based medical management had no significant effect on nocturnal ventricular ectopy or tachyarrhythmia over a period of 12 months in alive patients with HFrEF and CSA. Findings do not further support the hypothesis that ASV may lead to sudden cardiac death by triggering ventricular tachyarrhythmia.

Central sleep apnoea: not just one phenotype

“…Interestingly, in a sub-study of the SERVE-HF trial, there was no significant effect on nocturnal ventricular ectopy or tachyarrhythmia over a period of 12 months in living patients with HFrEF and CSA. Hence, these do not support the hypothesis that ASV may lead to sudden cardiac death by triggering ventricular tachyarrhythmia [123]. The findings of SERVE-HF have been criticised due to technical differences and limitations of the study performance [124].…”

Ventricular arrhythmias in patients with chronic heart failure and central sleep apnea with Cheyne-Stokes respiration

“…таким образом, цас было связано с возникновением Жт независимо от статуса сна/бодрствования у пациентов с сннфв и независимо предсказывало возникновение Жт. вспомогательный перекрёстный анализ включил 239 участников основного субисследования serVe-hf [46] с сннфв и цас. высокая частота желудочковых аритмий наблюдалась у 44% больных.…”