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1. Nasal CPAP: the new cardiac resynchronization therapy?

   • Maria E Ocasio-Tascon, MD
   • William Rodriguez-Cintron

   San Juan VAMC

   McAlister and associates have summarized the clinical trials testing the effectiveness of cardiac resynchronization therapy (CRT) in Congestive Heart Failure (CHF) (1). On this same issue Nichol and coworkers analyzed the cost-effectiveness of using CRT in patients with CHF (2). Mounting evidence toward the use of nasal continuous positive airway pressure (nCPAP) therapy in CHF patients has been documented lately (3).

   We recently demonstrated in 52 patients with CHF due to ischemic cardiomyopathy (New York Heart Classification II-III) and no evidence of sleep-disordered breathing that nCPAP therapy significantly increased left ventricular ejection fraction (LVEF). Subjects with baseline LVEF (less than 19%)were the ones who benefited the most, and their Q-T intervals (corrected for heart rate) shortened and heart rate decreased significantly. All of these findings were after one month of therapy, without associated changes in body mass index or drug therapy, with a nCPAP pressure of 8 cm H2O and with an average 3.3 hours/night of usage (4). The role of nCPAP therapy in the treatment algorithm of CHF (5) should be established by randomized clinical trials addressing the efficacy and electrophysiological findings associated with nCPAP. nCPAP should be thought as a non-invasive tool to improve the coordination and efficiency of left ventricular contraction in selected subjects. Trials should target the efficacy and cost effectiveness of nCPAP versus CRT.

   References:

   1.McALister FA, Ezekowitz JA, Wiebe N, Rowe B, Spooner C, Crumley E, et al. Systematic review: cardiac resynchronization therapy in patients with symptomatic heart failure. Ann Intern Med. 2004; 141:391-400. 2. Nichol G, Kaul P, Hustzi E, Bridges JF. Cost-effectiveness of cardiac resynchronization therapy in patients with symptomatic heart failure. Ann Intern Med. 2004; 141:343-351. 3. Midleton G, Frishman W, Passo S. Congestive Heart Failure and CPAP therapy: Support of a new modality fro improving the prognosis and survival of patients with advanced heart failure. Heart Disease 2002; 4: 102-109 4.Ocasio-Tascon ME, Martinez M, Rodriguez W, et al. Nasal continuous positive airway pressure: the new resynchronization therapy in heart failure. AJRCCM 2004; 169: A466. 5. Jessup M, Brozena S. Medical progress: Heart Failure. N Engl J Med. 2003; 348: 2007-2018.

   Conflict of Interest:

   None declared

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   Published August 19, 2004