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Treatment of Obstructive Sleep Apnea Reduces the Risk of Atrial Fibrillation Recurrence Following Catheter Ablation
Study Questions:
Does continuous positive airway pressure (CPAP) therapy reduce atrial fibrillation (AF) recurrence in patients with obstructive sleep apnea (OSA) undergoing radiofrequency catheter ablation (RFA)?
Methods:
Among 426 patients who underwent RFA between 2007 and 2010 at a single center, 62 patients had a polysomnography-confirmed diagnosis of OSA. An apnea-hypopnea index of >15 events/hour (and 80% of all events being obstructive apnea) was required for the definition of OSA. While 32 patients were “CPAP users,” the remaining 30 patients were “CPAP nonusers.” “CPAP users” had used CPAP daily for a minimum of 3 months prior to RFA and continued to use CPAP throughout the follow-up duration. There were no crossovers between the groups. The recurrence of any atrial tachyarrhythmia, use of antiarrhythmic drugs, and need for repeat ablations were compared between the groups during a follow-up period of 12 months. Additionally, the outcome of patients with OSA was compared to a group of patients from the same ablation cohort without OSA.
Results:
Patients’ mean age, body mass index, left atrial size, and percentage of persistent AF was balanced among the study groups. During a follow-up period of 1 year, 23 of the 32 “CPAP-users” and 11 of the 30 “CPAP nonusers” and 20 of the 30 non-OSA patients remained in sinus rhythm following RFA. The atrial tachyarrhythmia-free survival rate was significantly higher in the “CPAP users” compared with the “CPAP nonusers” (71.9% vs. 36.7%; p = 0.01); and similar to that of patients without OSA (66.7%; p = 0.94). There was no significant difference in the frequency of repeat ablation procedures between the CPAP users, CPAP nonusers, and non-OSA control group (15.6%, 26.7%, 20%; p = 0.56). In a four-group univariate analysis, the presence of hypertension (p = 0.04) and persistent AF (p < 0.01) was negatively associated with AF-free survival.
Conclusions:
The authors concluded that: 1) OSA patients treated with CPAP had significantly improved outcome following RFA with overall lower arrhythmia recurrence rate, and 2) arrhythmia-free survival off antiarrhythmic drugs was significantly higher in patients treated with CPAP.
Perspective:
This study demonstrates that CPAP therapy is associated with better procedural outcome in the OSA patient population undergoing RFA. However, before withholding invasive RFA treatment of AF patients without optimized OSA therapy, larger studies are needed.
Keywords: Survival Rate, Continuous Positive Airway Pressure, Catheter Ablation, Hypertension, Sleep Apnea, Obstructive, Tachycardia
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