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 (ASV_PF) in patients with heart failure with reduced ejection fraction (HFrEF).

Aims and objectives. To assess the effects of ASV_PF on NCA and nocturnal heart rate (NHR) after 1 month of treatment.

Methods. In ADVENT-HF HFrEF patients were randomized to ASV_PF or to no treatment of OSA or CSA (control). ASV_PF (n=206) and control (n=243) patients whose nocturnal electrocardiogram from polysomnography were technically adequate at baseline and at 1 month were included.

Results. ASV_PF reduced the apnoea-hypopnoea index (median [interquartile range] ASV_PF 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 ASV_PF and control groups (p=0.696). ASV_PF 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. ASV_PF 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 ASV_PF reduces NCA or that ASV_PF may trigger NCA in patients with HFrEF.