Ventricular arrhythmia, Cheyne-Stokes respiration and death: observations from patients with defibrillators

Andrew D Staniforth ^1*, Simon C Sporton ², Mark J Early ², Jadwiga A Wedzicha ², Anthony W Nathan ² and Richard J Schilling ²

¹ Queens Medical Centre University Hospital, Nottingham, United Kingdom
² St Bartholomew's Hospital, London, United Kingdom

^* To whom correspondence should be addressed. E-mail: adstaniforth{at}beeb.net.

Accepted 26 November 2004

Abstract

Background: Cheyne-Stokes respiration (CSR) is an independent marker of death in heart failure.

Objective: To determine whether ventricular arrhythmia related to nocturnal hypoxaemia during CSR explains this observation.

Design: Prospective, observational study.

Patients: 101 subjects at high risk of clinical serious ventricular arrhythmia fitted with an internal cardiac defibrillator (ICD).

Measurements: Patients were studied at baseline for CSR during sleep. Arrhythmia requiring device therapy was used as a surrogate marker for possible sudden cardiac death.

Results: 101 subjects (42 with CSR) were followed for a total of 620 months. 432 ICD therapy episodes were observed in 26 subjects. 24 (6%), 210 (49%), 125 (29%) and 73 (17%) episodes occurred across the time quartiles 00-05:59, 06:00-11:59, 12:00-17:59 and 18:00-23:59 respectively. Kaplan-Meier analysis showed a relative risk (95% CI) of 1 (0.4-2.2; p=1) for device therapy in the CSR group. The average (SED) number of nocturnal therapies per patient per month of follow-up were 0.01 (0.01) and 0.04 (0.02) for subjects with and without CSR respectively (p=0.6).

Conclusion: Our findings refute the proposition that CSR increases heart failure death by promoting ventricular arrhythmia.

Keywords: cardiac defibrillator (ICD), cheyne-stokes respiration, sleep apnoea, ventricular tachyarrhythmia

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