Cardiac arrhythmias associated with volume-assured pressure support mode in a patient with autonomic dysfunction and mitochondrial disease.

Abstract

NONE:

A 15-year-old boy with autonomic dysfunction and mitochondrial disease was diagnosed with sleep-related hypoventilation at 6 years of age and treated with bilevel positive airway pressure therapy. At 12 years of age, treatment was transitioned to volume-assured pressure support (VAPS) due to clinical evidence of respiratory muscle weakness. Subsequent titration polysomnogram revealed the emergence of cardiac arrhythmia (isolated premature ventricular contractions, bigeminy, and trigeminy) while on VAPS mode that improved after transition to bilevel positive airway pressure therapy. During the titration study, higher tidal volumes correlated with increased pressures and the presence of arrhythmia. Prior to initiation of VAPS therapy, the patient had normal electrocardiogram evaluations. This case highlights the potential relationship between VAPS therapy and cardiac arrhythmias, especially in patients with underlying conditions with associated cardiac abnormalities, such as autonomic dysfunction and mitochondrial disease. While using VAPS mode, patients should be closely monitored for cardiac rhythm abnormalities.

• Authors: Hina Emanuel, Katie Ahlstrom, Sarah Mitchell, Katrina McBeth, Aravind Yadav, Carlos Flores Oria, Candice Da Costa, James M Stark, Ricardo A Mosquera, Cindy Jon
• Journal: Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine (J Clin Sleep Med) Vol. 17 Issue 4 Pg. 853-857 (04 01 2021) ISSN: 1550-9397 [Electronic] United States
• PMID: 33231166 (Publication Type: Case Reports)
• Copyright: © 2021 American Academy of Sleep Medicine.

Topics

• Adolescent
• Arrhythmias, Cardiac
• Humans
• Hypoventilation
• Male
• Mitochondrial Diseases
• Positive-Pressure Respiration
• Tidal Volume