The SERVE-HF trial investigated the effect of treating central sleep apnoea (CSA) with adaptive servo-ventilation (ASV) in patients with heart failure with reduced ejection fraction (HFrEF). The aim of the present ancillary analysis of the SERVE-HF major substudy (NCT01164592) was to assess the effects of ASV on the burden of nocturnal ventricular arrhythmias (premature ventricular complexes and non-sustained ventricular tachycardia) as one possible mechanism for sudden cardiac death in ASV-treated patients with HFrEF and CSA.

312 patients were randomised in the SERVE-HF major substudy (no treatment of CSA [control] versus ASV). Polysomnography including nocturnal ECG fulfilling technical requirements was performed at baseline (n=239), and at 3 (n=167) and 12 (n=141) months. Premature ventricular complexes (events/h of total recording time) and non-sustained ventricular tachycardia were assessed. Linear mixed models and generalized linear mixed models were used to analyse differences between the control and ASV groups, and changes over time.

From baseline to 3- and 12-month follow-up, respectively, the number of premature ventricular complexes and the occurrence of ≥1 non-sustained ventricular tachycardia/night were similar in the control and ASV groups (Table 1). Across and within all prespecified subgroups, no different treatment effects (control vs ASV) on nocturnal PVC/h were observed, including in subgroups based on baseline LVEF (<30% vs ≥30%), the proportion of CSR (<20% vs ≥20%) and baseline PVCs (>30/h vs ≤30/h) (Figure 1).

In patients with HFrEF and CSA, addition of ASV to guideline-based medical management had no significant effect on ventricular arrhythmias over a period of 12 months. Findings do not support the hypothesis that ASV may lead to sudden cardiac death by triggering ventricular tachyarrhythmia.