ISSN 2996-8215
International Journal of Cardiology | Vol. 8, No. 6, June 2017 | pp. 41–48
DOI: 10.46882/2017/IJC/000099
Original Research Article
Impact of Obstructive Sleep Apnea Severity on Atrial Fibrillation Recurrence After Radiofrequency Catheter Ablation
Marc-André Dubois¹, Thomas Keller², Lukas Weber²
¹Department of Cardiology, Hôpital Cardiovasculaire Louis Pradel, Lyon, France
²Division of Electrophysiology, University Hospital Zurich, Zurich, Switzerland
Abstract:
Obstructive sleep apnea (OSA) is highly prevalent in patients with atrial fibrillation (AF) and promotes continuous atrial electrical and structural remodeling. However, the direct impact of unrecognized or untreated OSA severity on long-term arrhythmia recurrence following radiofrequency catheter ablation remains incompletely quantified. This prospective study evaluated the relationship between the apnea-hypopnea index (AHI) measured via pre-procedural polysomnography and post-ablation AF recurrence. We enrolled 150 patients with symptomatic paroxysmal or persistent AF scheduled for their first catheter ablation (pulmonary vein isolation). All patients underwent overnight polysomnography prior to the procedure. OSA was defined as an AHI greater than or equal to 5 events per hour and categorized into mild (5–14.9), moderate (15–29.9), and severe (greater than or equal to 30). Recurrence was defined as any documented atrial tachyarrhythmia lasting longer than 30 seconds after a 3-month blanking period. OSA was diagnosed in 78 patients (52.0%). Over a 24-month follow-up, arrhythmia recurrence was significantly higher in patients with OSA than in those without OSA (48.7% vs. 27.8%, p = 0.01). Recurrence rates exhibited a dose-dependent relationship with OSA severity, reaching 64.0% in the severe OSA subgroup. Multivariable Cox proportional hazards regression identified severe OSA (AHI greater than or equal to 30) as a potent, independent predictor of AF recurrence (hazard ratio: 2.45, 95% CI: 1.34–4.48, p = 0.003). Sleep apnea severity is strongly and independently associated with higher rates of atrial fibrillation recurrence after catheter ablation.
Keywords: Atrial fibrillation, Catheter ablation, Obstructive sleep apnea, Apnea-hypopnea index, Recurrence, Polysomnography, Rhythm control
Received: March 11, 2012; Revised: April 25, 2012; Accepted: May 12, 2012; Published: June 19, 2017