7 Exploitability and Distribution of Sleep Apnea and Atrial Fibrillation Burden During Long Term Follow-Up in Unselected Dual-Chamber Pacemaker Patients

Abstract

Background Sleep Apnea (SA) and Atrial Fibrillation (AF) are common comorbidities in paced patients (pts). Modern pacemakers (PMs) are capable of storing continuous long-term reliable daily information about: 1) AF burden (AFB); 2) severity of SA, defined by a respiratory disturbances index (RDI) measured by a minute ventilation sensor-based algorithm. Aim of the study This retrospective study aimed to assess exploitability and distributions of daily AFB and RDI over long-term follow-up (FU) in unselected dual-chamber (DC) paced pts implanted with PMs equipped with a dedicated SA monitoring (SAM) algorithm and followed-up in their Institutions. Pts affected by permanent AF were excluded from the study. Methods Data from long-term FU have been collected after implant, together with pts clinical baseline characteristics. Between Aug 2013 and Oct 2018, n=210 pts were implanted with Reply 200/Kora 100 PMs (MicroPort CRM, Saluggia-VC, Italy), equipped with the SAM algorithm. At each FU visit all the daily AFB and RDI data were retrieved from the PM memory. Days of FU have been considered exploitable (Expl-FU) when both the daily AFB and RDI information were available. Results Data from n=864 visits are available for analysis. Pts characteristics: male 56.2%, mean age 76.4±11.1 yrs, BMI 25.6±4.4 Kg/m2; implant indication: sinus node disease 40.5%, AV block 46.2%; 37.1% of pts had a history of paroxysmal AF. The overall FU / Expl-FU durations were 1.94±1.23 / 1.48±1.14 years (23.7% of days were lost due to various technical reasons). The PMs classified RDI as valid in 92.3%±19.5% of nights (85.7% of pts showed >90% of valid nights, Figure 1). Severe or moderate SA was suspected in 43.8% and 59.5% of pts, respectively. An AFB≥25% / 50% was observed in 9.5% / 5.7% of pts (Figure 2). Conclusions In this retrospective study, SA and AF have been shown to highly affect unselected DC paced pts. PM devices proved to be really helpful in consistently and reliably measure both SA (RDI successfully identified in 92.3%±19.5% of nights) and AF (9.5% of pts with AFB≥25%). This is relevant to allow clinicians to implement early preventive actions to improve clinical prognosis.