Abstract 9984: Concomitant Sleep-Disordered Breathing Increases the Recurrence of Atrial Fibrillation Following Radiofrequency Catheter Ablation of Atrial Fibrillation: Efficacy of CPAP Therapy

Abstract

Background: Recent studies have suggested an emerging link between obstructive sleep apnea (OSA) and atrial fibrillation (AF). Patients with OSA are reported to be less likely to maintain sinus rhythm after radiofrequency (RF) catheter ablation of AF. Continuous positive airway pressure (CPAP) is a well-established treatment for OSA. However, the effect of the CPAP on AF recurrences following ablation has not been clarified. Methods: This study prospectively included 133 patients (20 women; 57±11 years) who underwent RF catheter ablation for drug-refractory AF. At 1 week after the ablation, a standard overnight polysomnographic evaluation was performed, and the total duration and number of episodes of central or obstructive sleep apnea or hypopnea were examined. The primary endpoint was the recurrence of AF after the RF catheter ablation of AF. Results: The overnight polysomnography revealed no sleep-disordered breathing in 30 patients (23%; No-OSA-Gr). However, 103 (77%) patients were identified as having OSA by the overnight polysomnography. Sixty-one (59%) of those 103 patients received CPAP therapy (CPAP-Gr), and the remaining 42 (41%) did not (No-CPAP-Gr). After a mean follow-up period of 12.3±4.1 months, the prevalence of AF recurrences was 36% in the No-CPAP-Gr patients, which was greater than that in the CPAP-Gr (11%) and No-OSA-Gr (10%; p=0.003) patients. A multivariate analysis revealed that the OSA (hazard ratio [HR]= 4.082, 95% confidence interval [CI]= 1.083-15.388, P=0.038), usage of CPAP (HR= 0.236, 95% CI= 0.091-0.614, P=0.003), total duration of the AF history (HR= 1.084, 95% CI 1.024-1.144, P=0.011), and left atrial volume (HR=1.120, 95% CI=1.010-1.239, P=0.029) were independent predictors of AF recurrences. An AHI of > 10 by PSG identified an AF recurrence after the RF catheter ablation of AF with a sensitivity of 67% and specificity of 83% (area under the curve= 0.752, P=0.003). Conclusions: Patients with untreated OSA have a higher recurrence of AF after ablation. The CPAP treatment is effective for AF recurrences as well as for OSA patients, and should be performed after AF ablation.