Effect of adaptive servo-ventilation on cardiac repolarization in patients with myocardial infarction and sleep-disordered breathing

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Background: The prospective multicenter study TEAM-ASV-I investigated the effect of early treatment with adaptive servo-ventilation (ASV) in addition to percutaneous coronary intervention (PCI) and optimal medical therapy in first acute myocardial infarction (AMI). The aim of this subanalysis was to assess the effect of ASV on cardiac repolarization as surrogate for malignant ventricular arrhythmias. Methods: This ancillary analysis included 42 participants from the TEAM-ASV study, 22 with and 20 without ASV. Cardiac repolarization was assessed by means of T-peak-to-end (TpTec) and QTc-intervals and TpTe/QT-ratios derived from 12-lead ECG before, 4 and 12 weeks after PCI. Results: The population was predominantly male (79%), overweight (BMI 31±6 kg/m²) and had severe sleep-disordered breathing (AHI 34±18/h). Baseline parameters did not differ between the ASV and the non-ASV group. ASV was initiated within 2.6±1 days after AMI. AHI was lower in the ASV than in the non-ASV group after 12 weeks (3±7/h vs. 26±21/h, p<0.001). From baseline to 4 weeks, QTc significantly decreased in the ASV compared to the non-ASV group (−5.8% vs. -1.2%, p=0.041). A similar trend was seen with respect to TpTec (−18.0% vs. -6.8%, p=0.119) and TpTe/QT (−17.6% vs. -6.6%, p=0.252). After 12 weeks, the decline of repolarization times was similar between the groups (QTc: -7.6% vs. -4.5%, p=0.400; TpTec: -19.3% vs. -18.8%, p=0.400; TpTe/QT: -9.7 vs. -13.0, p=0.652). Conclusion: In patients with first AMI and SDB, treatment with ASV reduced cardiac repolarization after 4 weeks, but not after 12 weeks. This may help to prevent ventricular arrhythmias in the vulnerable early phase after AMI.

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