Polysomnography and implantable cardiac devices: Identifying normal and abnormal paced beats

Vikas Mittal, Michael S Lloyd, Nancy A Collop

Case study

A 57-year-old gentleman never smoker was referred to our sleep center. He had a history of surgical repair for Tetralogy of Fallot in childhood with preservation of his pulmonary valve. A biventricular pacemaker-defibrillator (Medtronic 7299 In-Sync, Minneapolis, MN) was implanted 6 years prior for high-grade AV block. Prior interrogations of his device revealed underlying atrial fibrillation and pacemaker dependence but normal lead function. He was diagnosed with obstructive sleep apnea (OSA) by polysomnography (November 2010) with a respiratory disturbance index (RDI) of 22.2 and an apnea hypopnea index (AHI) of 20.5.