Abstract
Atrial overdrive pacing markedly improved sleep disordered breathing in a recent study. Using a single blinded, randomized, crossover design, we aimed to reproduce these findings and investigate the possible underlying mechanisms. Twenty ambulatory patients with an implanted pacemaker or cardioverter defibrillator were studied by polysomnography on three 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 per minute faster than the mean nocturnal heart rate. Ventilation (Respitrace) and biomarkers (urinary norepinephrine excretion, aminoterminal portion of the precursor of brain natriuretic peptide (NTproBNP)) were also evaluated. 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 ratedependent reduction in the hypopnea index was evoked by pacing. The lack of effect on the apnea-hypopnea index means that atrial overdrive pacing is inappropriate for treating sleep disordered breathing.
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