Atrial Remodeling in Obstructive Sleep Apnea: Implications for Atrial Fibrillation

Study Questions:

Does obstructive sleep apnea (OSA) cause atrial remodeling?


Twenty patients (mean age 55 years) with moderate to severe OSA and a control group of 20 patients (mean age 51 years) with none to mild OSA underwent radiofrequency catheter ablation of paroxysmal atrial fibrillation (AF). Atrial electrophysiological parameters were measured before ablation.


There was no significant difference in atrial refractoriness between the two groups. Atrial conduction was slower and sinus node recovery time was prolonged in the OSA group. Electroanatomical voltage mapping demonstrated lower bipolar voltage in the OSA group. Regions of scar were present in the OSA group, but not in the control group. During AF, complex atrial fractionated electrograms were more prevalent in the patients with OSA.


The authors concluded that OSA is associated with changes in atrial electrophysiological parameters that reflect atrial remodeling.


Several studies have demonstrated that OSA is associated with AF independent of obesity. In addition, patients with OSA are more likely to have recurrent AF after transthoracic cardioversion and catheter ablation. The findings of this study provide a possible explanation for why OSA predisposes to AF.

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Implantable Devices, EP Basic Science, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Sleep Apnea

Keywords: Heart Atria, Cicatrix, Electric Countershock, Atrial Remodeling, Obesity, Sinoatrial Node, Electrophysiologic Techniques, Cardiac, Catheter Ablation, Sleep Apnea, Obstructive, Sleep Apnea Syndromes

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