Nocturnal Cardiac Arrhythmias in Sleep Apnoea After Acute Myocardial Infarction and the Effect of Adaptive Servo-Ventilation: An Ancillary Study of the TEAM-ASV I Trial.

(1)

Background

Early treatment of sleep-disordered breathing (SDB) with adaptive servo-ventilation (ASV) after acute myocardial infarction (AMI) has been shown to improve myocardial salvage. This analysis evaluates nocturnal electrocardiogram (ECG) Holter data, derived from polygraphy in a randomised clinical trial (NCT02093377), to assess the occurrence of nocturnal cardiac arrhythmias in patients with SDB and to explore the effect of ASV therapy. (2)

Methods

In the TEAM-ASV I trial, patients were stratified by the presence/absence of SDB, defined by an apnoea-hypopnoea index (AHI) ≥15 events/h assessed with polygraphy. Those with SDB were subsequently randomised to receive ASV in addition to standard AMI care. Guideline-conforming semi-automated ECG analysis of nocturnal cardiac arrhythmias was conducted via Holter-ECG software (custo diagnostic, version 5.4). (3)

Results

Patients with SDB had an increased incidence of non-sustained ventricular tachycardia (NSVT) (SDB: n = 8 (16%) vs. no SDB: n = 1 (2%); p = 0.024) and premature atrial contractions (PAC) (SDB: 1.2/h [0.3, 3.4] vs. no SDB: 0.3/h [0.1, 1.2]; p = 0.017). In patients with SDB who were randomised to ASV treatment early after AMI, we found no reduction in cardiac arrhythmias when ASV was added to standard care. (4)

Conclusions

After AMI, SDB was linked to increased NSVT and PAC. ASV treatment demonstrated neither a harmful nor a beneficial effect on the occurrence of nocturnal cardiac arrhythmias. Further trials are warranted to confirm these findings.