Background. Triggering of nocturnal cardiac arrhythmias (NCA) may occur by obstructive and central sleep apnea (OSA, CSA), and adaptive servo-ventilation. The ADVENT-HF trial investigated the effect of treating OSA and CSA with peak airflow-triggered adaptive servo-ventilation (ASVPF) in patients with heart failure with reduced ejection fraction (HFrEF).
Aims and objectives. To assess the effects of ASVPF on NCA and nocturnal heart rate (NHR) after 1 month of treatment.
Methods. In ADVENT-HF HFrEF patients were randomized to ASVPF or to no treatment of OSA or CSA (control). ASVPF (n=206) and control (n=243) patients whose nocturnal electrocardiogram from polysomnography were technically adequate at baseline and at 1 month were included.
Results. ASVPF reduced the apnoea-hypopnoea index (median [interquartile range] ASVPF vs. control: -31 [-47;-21] vs. -1 [-11;9]/hour; p<0.001), but had no significant effect on the frequency of premature atrial and ventricular complexes compared to control (0.0 [-0.6;0.6] vs. 0.0 [-0.6;1.1]/hour and -0.1 [-10.6;9.2] and 0.6 [-11.4;21.9]/hour, respectively). The change of the occurrence of non-sustained ventricular tachycardia was similar in the ASVPF and control groups (p=0.696). ASVPF reduced NHR in the total population (-2.0 [-5.0;1.0] vs. 0.0 [-3.0;3.0]/min; p=0.005) and in OSA (-2.0 [-5.0;1.0] vs. 0.0 [-3.0;3.0]/min; p=0.007), but not in the CSA patients.
Conclusions. ASVPF modestly reduced NHR in HFrEF patients with OSA, but had no effect on NCA. These findings do not support the hypotheses that treatment of OSA and CSA with ASVPF reduces NCA or that ASVPF may trigger NCA in patients with HFrEF.