Skip to main content
SpringerLink
Log in

Diagnostic Tools: Messages from Implanted Devices (Pacemakers as Diagnostic Tools)

  • Chapter
  • First Online:
The Breathless Heart

  • 580 Accesses

Abstract

In this chapter a review of the diagnostic power of the new-generation implantable devices is provided. The chapter offers a detailed description of the different devices with the main characteristic and clinical utility. Two up-to-date manufacturers are selling devices able to record respiratory signals and, through specific algorithms, to detect the presence and quantify the prevalence of sleep apneas. The accuracy of these methods is still under evaluation in ongoing studies, but the possibility to employ these devices and software for screening of apneas and evaluation of response to treatment is an interesting opportunity in patients with heart failure who require an implantable device.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.00
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Abbreviations

AF:

Atrial fibrillation

AHI:

Apnea-hypopnea index

CPAP:

Continuous positive airway pressure therapy

CRT:

Cardiac resynchronization therapy

CSA:

Central sleep apnea

HF:

Heart failure

ICD:

Implantable cardioverter defibrillator

LVEF:

Left ventricular ejection fraction

OSA:

Obstructive sleep apnea

PSG:

Polysomnography

RDE:

Respiratory disturbance event

SA:

Sleep apnea

References

  1. Sin DD, Fitzgerald F, Parker JD, Newton G, Floras JS, Bradley TD. Risk factors for central and obstructive sleep apnea in 450 men and women with congestive heart failure. Am J Respir Crit Care Med. 1999;160:1101–6.

    Article  CAS  PubMed  Google Scholar 

  2. Vazir A, Hastings PC, Dayer M, McIntyre HF, Henein MY, Poole-Wilson PA, Cowie MR, Morrell MJ, Simonds AK. A high prevalence of sleep disordered breathing in men with mild symptomatic chronic heart failure due to left ventricular systolic dysfunction. Eur J Heart Fail. 2007;9:243–50.

    Article  CAS  PubMed  Google Scholar 

  3. Javaheri S. Sleep disorders in systolic heart failure: a prospective study of 100 male patients. The final report. Int J Cardiol. 2006;106:21–8.

    Article  PubMed  Google Scholar 

  4. Javaheri S, Parker TJ, Liming JD, Corbett WS, Nishiyama H, Wexler L, Roselle GA. Sleep apnea in 81 ambulatory male patients with stable heart failure. Types and their prevalences, consequences and presentations. Circulation. 1998;97:2154–9.

    Article  CAS  PubMed  Google Scholar 

  5. Mooe T, Franklin KA, Holmstrom K, Rabben T, Wiklund U. Sleep-disordered breathing and coronary artery disease: long-term prognosis. Am J Respir Crit Care Med. 2001;164:1910–3.

    Article  CAS  PubMed  Google Scholar 

  6. Lanfranchi PA, Braghiroli A, Bosimini E, Mazzuero G, Colombo R, Donner CF, Giannuzzi P. Prognostic value of nocturnal cheyne-stokes respiration in chronic heart failure. Circulation. 1999;99:1435–40.

    Article  CAS  PubMed  Google Scholar 

  7. Naughton M, Benard D, Tam A, Rutherford R, Bradley TD. Role of hyperventilation in the pathogenesis of central sleep apneas in patients with congestive heart failure. Am Rev Respir Dis. 1993;148:330–8.

    Article  CAS  PubMed  Google Scholar 

  8. Gabor JY, Newman DA, Barnard-Roberts V, Korley V, Mangat I, Dorian P, Hanly PJ. Improvement in cheyne-stokes respiration following cardiac resynchronisation therapy. Eur Respir J. 2005;26:95–100.

    Article  CAS  PubMed  Google Scholar 

  9. Jaffe LM, Kjekshus J, Gottlieb SS. Importance and management of chronic sleep apnoea in cardiology. Eur Heart J. 2013;34(11):809–15.

    Article  PubMed  Google Scholar 

  10. Garrigue S, Pepin JL, Defaye P, Murgatroyd F, Poezevara Y, Clémenty J, Lévy P. High prevalence of sleep apnea syndrome in patients with long-term pacing: the European multicenter polysomnographic study. Circulation. 2007;115:1703–9.

    Article  PubMed  Google Scholar 

  11. Kasai T, Bradley TD. Obstructive sleep apnoea and heart failure. J Am Coll Cardiol. 2011;57:119–27.

    Article  PubMed  Google Scholar 

  12. Arzt M, Young T, Finn L, Skatrud JB, Ryan CM, Newton GE, Mak S, Parker JD, Floras JS, Bradley TD. Sleepiness and sleep in patients with both systolic heart failure and obstructive sleep apnea. Arch Intern Med. 2006;166:1716–22.

    Article  PubMed  Google Scholar 

  13. Bradley TD, Floras JS. Sleep apnea and heart failure: part I: obstructive sleep apnea. Circulation. 2003;107:1671–8.

    Article  PubMed  Google Scholar 

  14. Bradley TD, Floras JS. Sleep apnea and heart failure: part II: central sleep apnea. Circulation. 2003;107:1822–6.

    Article  PubMed  Google Scholar 

  15. Grimm W, Sharkova J, Heitmann J, Jerrentrup A, Koehler U, Maisch B. Sleep-disordered breathing in recipients of implantable defibrillators. PACE. 2009;32:S8–11.

    Article  PubMed  Google Scholar 

  16. Grimm W, Apelt S, Timmesfeld N, Koehler U. Sleep-disordered breathing in patients with implantable cardioverter-defibrillator. Europace. 2013;15(4):515–22.

    Article  PubMed  Google Scholar 

  17. Roche F, Xuong AN, Court-Fortune I, Costes F, Pichot V, Duverney D, Vergnon JM, Gaspoz JM, Barthélémy JC. Relationship among the severity of sleep apnea syndrome, cardiac arrhythmias, and autonomic imbalance. Pacing Clin Electrophysiol. 2003;26:669–77.

    Article  PubMed  Google Scholar 

  18. Gami AS, Howard DE, Olson EJ, Somers VK. Day-night pattern of sudden death in obstructive sleep apnea. N Engl J Med. 2005;352:1206–14.

    Article  CAS  PubMed  Google Scholar 

  19. Tomaello L, Zanolla L, Vassanelli C, LoCascio V, Ferrari M. Sleep disordered breathing is associated with appropriate implantable cardioverter defibrillator therapy in congestive heart failure patients. Clin Cardiol. 2010;33:E27–30.

    Article  PubMed  Google Scholar 

  20. Bitter T, Westerheide N, Prinz C, Hossain MS, Vogt J, Langer C, Horstkotte D, Oldenburg O. Cheyne-stokes respiration and obstructive sleep apnoea are independent risk factors for malignant ventricular arrhythmias requiring appropriate cardioverter-defibrillator therapies in patients with congestive heart failure. Eur Heart J. 2011;32:61–74.

    Article  PubMed  Google Scholar 

  21. Gami AS, Hodge DO, Herges RM, Olson EJ, Nykodym J, Kara T, Somers VK. Obstructive sleep apnea, obesity, and the risk of incident atrial fibrillation. J Am Coll Cardiol. 2007;49:565–71.

    Article  PubMed  Google Scholar 

  22. Mehra R, Benjamin EJ, Shahar E, Gottlieb DJ, Nawabit R, Kirchner HL, Sahadevan J, Redline S. Association of nocturnal arrhythmias with sleep-disordered breathing: the sleep heart health study. Am J Respir Crit Care Med. 2006;173(8):910–6.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Gami AS, Pressman G, Caples SM, Kanagala R, Gard JJ, Davison DE, Malouf JF, Ammash NM, Friedman PA, Somers VK. Association of atrial fibrillation and obstructive sleep apnea. Circulation. 2004;110:364–7.

    Article  PubMed  Google Scholar 

  24. Kanagala R, Murali NS, Friedman PA, et al. Obstructive sleep apnea and the recurrence of atrial fibrillation. Circulation. 2003;107:2589–94.

    PubMed  Google Scholar 

  25. European Heart Rhythm Association (EHRA), European Society of Cardiology (ESC), Heart Rhythm Society, Heart Failure Society of America (HFSA), American Society of Echocardiography (ASE), American Heart Association (AHA), European Association of Echocardiography (EAE) of ESC, Heart Failure Association of ESC (HFA), Daubert JC, Saxon L, Adamson PB, Auricchio A, Berger RD, Beshai JF, Breithard O, Brignole M, Cleland J, DeLurgio DB, Dickstein K, Exner DV, Gold M, Grimm RA, Hayes DL, Israel C, Leclercq C, Linde C, Lindenfeld J, Merkely B, Mont L, Murgatroyd F, Prinzen F, Saba SF, Shinbane JS, Singh J, Tang AS, Vardas PE, Wilkoff BL, Zamorano JL, Anand I, Blomström-Lundqvist C, Boehmer JP, Calkins H, Cazeau S, Delgado V, Estes NA, Haines D, Kusumoto F, Leyva P, Ruschitzka F, Stevenson LW, Torp-Pedersen CT. EHRA/HRS expert consensus statement on cardiac resynchronization therapy in heart failure: implant and follow-up recommendations and management. Europace. 2012;14:1236–86.

    Article  Google Scholar 

  26. Authors/Task Force Members, Priori SG, Blomström-Lundqvist C, Mazzanti A, Blom N, Borggrefe M, Camm J, Elliott PM, Fitzsimons D, Hatala R, Hindricks G, Kirchhof P, Kjeldsen K, Kuck KH, Hernandez-Madrid A, Nikolaou N, Norekvål TM, Spaulding C, Van Veldhuisen DJ. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: the Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC) Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC). Eur Heart J. 2015;36(41):2793–867.

    Article  Google Scholar 

  27. Hatala R, Lunati M, Calvi V, Favale S, Goncalvesová E, Haim M, Jovanovic V, Kaczmarek K, Kautzner J, Merkely B, Pokushalov E, Revishvili A, Theodorakis G, Vatasescu R, Zalevsky V, Zupan I, Vicini I, Corbucci G. Clinical implementation of cardiac resynchronization therapy-regional disparities across selected ESC member countries. Ann Noninvasive Electrocardiol. 2015;20(1):43–52.

    Article  CAS  PubMed  Google Scholar 

  28. Agusti A, Hedner J, Marin JM, Barbé F, Cazzola M, Rennard S. Night-time symptoms: a forgotten dimension of COPD. Eur Respir Rev. 2011;20:183–94.

    Article  CAS  PubMed  Google Scholar 

  29. Shalaby A, Atwood C, Hansen C, Konermann M, Jamnadas P, Lee K, Willems R, Hartley J, Stahmann J, Kwok J, Ni Q, Neuzner J. Feasibility of automated detection of advanced sleep disordered breathing utilizing an implantable pacemaker ventilation sensor. Pacing Clin Electrophysiol. 2006;29:1036–43.

    Article  PubMed  Google Scholar 

  30. Defaye P, de la Cruz I, Martí-Almor J, Villuendas R, Bru P, Sénéchal J, Tamisier R, Pépin JL. A pacemaker transthoracic impedance sensor with an advanced algorithm to identify severe sleep apnea: the DREAM European study. Heart Rhythm. 2014;11(5):842–8.

    Article  PubMed  Google Scholar 

  31. Mond HG, Proclemer A. The 11th world survey of cardiac pacing and implantable cardioverter-defibrillators: calendar year 2009 – a World Society of Arrhythmia’s project. Pacing Clin Electrophysiol. 2011;34(8):1013–27.

    Article  PubMed  Google Scholar 

  32. Simon R, Ni Q, Willems R, Hartley JW, Daum DR, Lang D, Ward K, Gill J. Comparison of impedance minute ventilation and direct measured minute ventilation in a rate adaptive pacemaker. Pacing Clin Electrophysiol. 2003;26(11):2127–33.

    Article  PubMed  Google Scholar 

  33. Scharf C, Cho YK, Bloch KE, Brunckhorst C, Duru F, Balaban K, Foldvary N, Liu L, Burgess RC, Candinas R, Wilkoff BL. Diagnosis of sleep-related breathing disorders by visual analysis of transthoracic impedance signals in pacemakers. Circulation. 2004;110:2562–7.

    Article  PubMed  Google Scholar 

  34. Defaye P, Pepin JL, Poezevara Y, Mabo P, Murgatroyd F, Lévy P, Garrigue S. Automatic recognition of abnormal respiratory events during sleep by a pace-maker transthoracic impedance sensor. J Cardiovasc Electrophysiol. 2004;15:1034–40.

    Article  PubMed  Google Scholar 

  35. Lamba J, Simpson CS, Redfearn DP, Michael KA, Fitzpatrick M, Baranchuk A. Cardiac resynchronization therapy for the treatment of sleep apnoea: a meta-analysis. Europace. 2011;13(8):1174–9.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank Ilaria Vicini (Boston Scientific) and Chiara Angelone (LivaNova) for skillful technical assistance.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Cardiology Unit, Ospedale del Mugello, Borgo San Lorenzo, Florence, Italy

    Margherita Padeletti MD & Fabrizio Bandini MD

  2. Cardiovascular Department, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy

    Edoardo Gronda MD & Luigi Padeletti MD

  3. Chair of Cardiology, University of Florence, Florence, Italy

    Luigi Padeletti MD

Authors
  1. Margherita Padeletti MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fabrizio Bandini MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Edoardo Gronda MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Luigi Padeletti MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Margherita Padeletti MD .

Editor information

Editors and Affiliations

  1. Fondazione Toscana Gabriele Monasterio, Pisa, Italy

    Michele Emdin

  2. Fondazione Toscana Gabriele Monasterio, Pisa, Italy

    Alberto Giannoni

  3. Fondazione Toscana Gabriele Monasterio, Pisa, Italy

    Claudio Passino

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Padeletti, M., Bandini, F., Gronda, E., Padeletti, L. (2017). Diagnostic Tools: Messages from Implanted Devices (Pacemakers as Diagnostic Tools). In: Emdin, M., Giannoni, A., Passino, C. (eds) The Breathless Heart. Springer, Cham. https://doi.org/10.1007/978-3-319-26354-0_11

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-26354-0_11

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-26352-6

  • Online ISBN: 978-3-319-26354-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation