1
|
Mazza A, Bendini MG, Bianchi V, Esposito C, Calò L, Andreoli C, Santobuono VE, Dello Russo A, Viscusi M, La Greca C, Baiocchi C, Talarico A, Albanese R, Arena G, Giubilato G, Ziacchi M, Rapacciuolo A, Campari M, Valsecchi S, Boriani G. Association Between Device-Detected Sleep-Disordered Breathing and Implantable Defibrillator Therapy in Patients With Heart Failure. JACC Clin Electrophysiol 2022. [DOI: 10.1016/j.jacep.2022.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/05/2022] [Accepted: 07/10/2022] [Indexed: 11/22/2022]
|
2
|
Boriani G, Diemberger I, Pisanò EC, Pieragnoli P, Locatelli A, Capucci A, Talarico A, Zecchin M, Rapacciuolo A, Piacenti M, Indolfi C, Arias MA, Checchinato C, La Rovere MT, Sinagra G, Emdin M, Ricci RP, D'Onofrio A. Association between implantable defibrillator-detected sleep apnea and atrial fibrillation: the DASAP-HF study. J Cardiovasc Electrophysiol 2022; 33:1472-1479. [PMID: 35499267 DOI: 10.1111/jce.15506] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 04/02/2022] [Accepted: 04/15/2022] [Indexed: 11/29/2022]
Abstract
AIM The Respiratory Disturbance Index (RDI) computed by an implantable cardioverter defibrillator (ICD) algorithm accurately identifies severe sleep apnea (SA). In the present analysis we tested the hypothesis that RDI could also predict AF burden. METHODS Patients with ejection fraction ≤35% implanted with an ICD were enrolled and followed-up for 24 months. One month after implantation, patients underwent a polysomnographic study. The weekly mean RDI value was considered, as calculated during the entire follow-up period and over a 1-week period preceding the sleep study. The endpoints were: daily AF burden of ≥5 minutes, ≥6 hours, ≥23 hours. RESULTS 164 patients had usable RDI values during the entire follow-up period. Severe SA (RDI≥30 episodes/h) was diagnosed in 92 (56%) patients at the time of the sleep study. During follow-up, AF burden ≥5 minutes/day was documented in 70 (43%), ≥6 hours/day in 48 (29%), and ≥23 hours/day in 33 (20%) patients. Device-detected RDI≥30 episodes/h at the time of the polygraphy, as well as the polygraphy-measured apnea hypopnea index ≥30 episodes/h, were not associated with the occurrence of the endpoints, using a Cox regression model. However, using a time-dependent model, continuously measured weekly mean RDI≥30episodes/h was independently associated with AF burden ≥5 minutes/day (HR:2.13, 95%CI:1.24-3.65, p=0.006), ≥6 hours/day (HR:2.75, 95%CI:1.37-5.49, p=0.004), and ≥23 hours/day (HR:2.26, 95%CI:1.05-4.86, p=0.037). CONCLUSIONS In heart failure patients, ICD-diagnosed severe SA on follow-up data review identifies patients who are from two- to three-fold more likely to experience an AF episode, according to various thresholds of daily AF burden. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
| | - Igor Diemberger
- University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | | | | | | | | | | | | | | | - Marcello Piacenti
- Institute of Life Science, Scuola Superiore Sant'Anna and Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Ciro Indolfi
- Division of Cardiology, "Magna Graecia" University, Catanzaro, Italy.,Mediterranea Cardiocentro, Naples, Italy
| | | | | | - Maria Teresa La Rovere
- Istituti Clinici Scientifici Maugeri, IRCCS, Istituto Scientifico di Montescano, Montescano, Pavia
| | | | - Michele Emdin
- Institute of Life Science, Scuola Superiore Sant'Anna and Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | | | | |
Collapse
|
3
|
Mazza A, Bendini MG, Leggio M, De Cristofaro R, Valsecchi S, Boriani G. Continuous monitoring of sleep-disordered breathing with pacemakers: Indexes for risk stratification of atrial fibrillation and risk of stroke. Clin Cardiol 2020; 43:1609-1615. [PMID: 33179808 PMCID: PMC7724201 DOI: 10.1002/clc.23489] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 11/19/2022] Open
Abstract
Background Sleep apnea (SA) is a risk factor for atrial fibrillation (AF). Advanced pacemakers are now able to calculate indexes of SA severity. Hypothesis We investigated the changes in pacemaker‐measured indexes of SA, we assessed their predictive value for AF occurrence and the associated risk of stroke and death at long‐term. Methods We enrolled 439 recipients of a pacemaker endowed with an algorithm for the calculation of a Respiratory Disturbance Index (RDI). The RDI variability was measured over the first 12 months after implantation, as well as its potential association with the occurrence of AF, defined as device‐detected cumulative AF burden ≥6 hoursours in a day. Results The individual RDI mean was 30 ± 18 episodes/h, and the RDI maximum was 59 ± 21 episodes/h. RDI ≥30 episodes/h was detected in 351 (80%) patients during at least one night. The proportion of nights with RDI ≥30 episodes/h was 14% (2%‐36%). AF ≥6 hours was detected in 129 (29%) patients during the first 12 months. The risk of AF was higher in patients with RDI maximum ≥63 episodes/h (HR:1.74; 95%CI: 1.22‐2.48; P = .001) and with RDI mean ≥ 46 episodes/h (HR:1.63; 95%CI: 1.03‐2.57; P = .014). The risk of all‐cause death or stroke was higher in patients with AF burden ≥6 hours (HR:1.75; 95%CI: 1.06‐2.86; P = .016). Moreover, among patients with no previous history of AF the risk was higher in those with RDI maximum ≥63 episodes/h (HR:1.96; 95%CI: 1.06‐3.63; P = .031). Conclusions Pacemaker‐detected SA showed a considerable variability during follow‐up. We confirmed the association between RDI and higher risk of AF, and we observed an association between higher RDI maximum and all‐cause death or stroke among patients with no previous history of AF.
Collapse
Affiliation(s)
- Andrea Mazza
- Cardiology Division, S. Maria della Stella Hospital, Orvieto, Italy
| | | | - Massimo Leggio
- Department of Medicine and Rehabilitation, Cardiac Rehabilitation Operative Unit, S. Filippo Neri Hospital, Rome, Italy
| | | | | | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| |
Collapse
|