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Atrial Overdrive Pacing in Patients with Sleep Apnea with Implanted Pacemaker

Department of Cardiology and Pneumology, Georg-August-Universität, Göttingen, Germany

Correspondence and requests for reprints should be addressed to Prof. Dr. S. Andreas, M.D., Herzzentrum Göttingen, Abteilung Kardiologie und Pneumologie, Georg-August-Universität Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany. E-mail: sandreas{at}med.uni-goettingen.de

Rationale: Atrial overdrive pacing markedly improved sleep-disordered breathing in a recent study. Objectives: Using a single-blind, randomized, crossover design, we aimed to reproduce these findings and investigate the possible underlying mechanisms. Methods: Twenty ambulatory patients with an implanted pacemaker or cardioverter defibrillator were studied by polysomnography on 3 consecutive nights in a randomized, single-blind, crossover study in which devices were programmed for nonpacing or for overdrive pacing at 7 or 15 beats/minute faster than the mean nocturnal heart rate. Ventilation and biomarkers (urinary norepinephrine excretion, amino-terminal portion of the precursor of brain natriuretic peptide, or NT-proBNP, were also evaluated. Measurements and Main Results: Neither the primary endpoint apnea–hypopnea index, nor the apnea index, oxygen desaturation, ventilation, or biomarkers were affected by the nocturnal atrial overdrive pacing. A small, clinically insignificant, rate-dependent reduction in the hypopnea index was evoked by pacing (nonpacing, 13.4 ± 1.4; pacing 7, 12.9 ± 1.4; pacing 15, 10.9 ± 1.0; p < 0.01, analysis of variance). Conclusions: The lack of effect on the apnea–hypopnea index means that atrial overdrive pacing is inappropriate for treating sleep-disordered breathing.

Key Words: pacing • randomized trial • sleep apnea

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