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Concomitant Obstructive Sleep Apnea Increases the Recurrence of Atrial Fibrillation Following Radiofrequency Catheter Ablation of Atrial Fibrillation: Clinical Impact of Continuous Positive Airway Pressure Therapy
Study Questions:
Can treatment of obstructive sleep apnea (OSA) reduce recurrences of atrial fibrillation (AF) after radiofrequency ablation (RFA)?
Methods:
A total of 249 consecutive patients with drug refractory AF undergoing RFA were screened from a single center from August 2009 to January 2011. Excluded were patients with prior RFA or those who refused to consent. All patients underwent standard overnight polysomnography within 1 week of RFA. OSA was diagnosed by an apnea-hypopnea index (AHI) >5 per hour. Adherence to treatment of OSA by continuous positive airway pressure (CPAP) was monitored by a modem connected to the CPAP device. Erratic usage of CPAP was <4 hours per night of the study period. Extensive encircling pulmonary vein isolation (PVI) was performed using a double-lasso technique. Procedural success was defined as the absence of AF lasting ≥30 seconds, off all antiarrhythmic drug therapies. A repeat RFA was not performed in any patient during the study period.
Results:
After exclusions, 153 patients (128 men and 25 women, ages 60 ± 9 years) were included. Of these, 82 (54%) patients had paroxysmal AF, and the remaining 71 (46%) had persistent AF. All patients had a history of unsuccessful treatment with 3.2 ± 1.2 antiarrhythmic drugs. Of 153 patients, 116 patients were identified as having OSA. Data regarding the use of CPAP and recurrences of AF were obtained in 82 patients. The remaining 34 patients with OSA were defined as the no-CPAP group. Polysomnography revealed no sleep disordered breathing in 37 patients. During a mean follow-up of 18.8 ± 10.3 months, 51 (33%) patients experienced AF recurrences after ablation. Regression analysis revealed the left atrial volume (hazard ratio [HR], 1.11; 95% confidence interval [CI], 1.01-1.23; p < 0.05), concomitant OSA (HR, 2.61; 95% CI, 1.12-6.09; p < 0.05), and usage of CPAP therapy (HR, 0.41; 95% CI, 0.22-0.76; p < 0.01) were associated with AF recurrences during the follow-up period.
Conclusions:
In this cohort, approximately three-fourths of patients with AF undergoing RFA had OSA diagnosed by overnight polysomnography. The authors concluded that patients with untreated OSA have a higher recurrence of AF after ablation. Appropriate treatment with CPAP in patients with OSA is associated with a lower recurrence of AF.
Perspective:
These findings suggest that there is a lower recurrence rate of AF after RFA among patients with OSA treated with CPAP. However, this study did not randomize the use of CPAP. It remains to be shown whether effects of CPAP long-term can preserve the positive outcomes seen with catheter-based therapies of AF in the subset with OSA. This and other studies provide a strong basis for a randomized clinical trial to determine whether CPAP reduces the risk of AF after RFA in patients with an AHI >5.
Keywords: Pulmonary Veins, Continuous Positive Airway Pressure, Confidence Intervals, Heart Rate, Catheter Ablation, Pregnancy, Sleep Apnea, Obstructive, Sleep Apnea Syndromes
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