Atrial premature beats during the Mueller manoeuvre are a predictor for arrhythmias

Abstract

Obstructive sleep apnoea (OSA) is associated with arrhythmias such as premature atrial beats (PABs) which can lead to paroxysmal atrial fibrillation and sudden cardiac death. The Mueller manoeuvre (MM) generates negative intrathoracic pressures similar to the ones observed during an obstructive apnoea. We tested the hypothesis whether PABs induced during a MM are associated with PABs recorded during a 24h-ECG and thus has the potential to be an indicator for the vulnerability of the heart. 12-lead-electrocardiograms were recorded continuously in 40 patients with paroxysmal atrial fibrillation during a MM. All patients underwent nocturnal respiratory polygraphic measurements and 24h-ECG. Associations were determined using linear regression adjusted for potential confounders. According to the sleep study, 50% of patients (age: 60±10 years, 5 females) had OSA (apnoea hypopnoea index ≥5). Multivariable regression analysis showed that APBs during the MM were associated with the number of PABs in the 24h-ECG (r=0.51, p PABs during the Mueller Manoeuvre seem to be a predictor for the spontaneous occurrence of PABs during night- and daytime. Patients with OSA seem to be especially vulnerable to cardiac arrhythmias such as PABs.