Causality in the relationship between central sleep apnea and paroxysmal atrial fibrillation

Abstract

The prevalence of central sleep apnea (CSA) is increased in patients with atrial fibrillation (AF) in addition to congestive heart failure [1]. Conversely, the prevalence of AF is increased in patients with idiopathic CSA in the absence of other cardiac disease [2]. The causality between CSA and AF and the etiologic relevance of congestive heart failure is not clear yet. A 52-year-old man with a stable three-vessel coronary artery disease was admitted because of suspected obstructive sleep apnea syndrome. The cardiorespiratory polygraphy revealed periodic breathing patterns following the onset of intermittent AF with a fast ventricular response and a heart rate up to 140 bpm (Figs. 1 and 2). CSA was not related to supine body position (Fig. 2). There were no ischemia-like electrocardiographic (ECG) changes associated with the development of CSA. Episodes of sinus rhythm with a heart rate of 60–80 bpm were accompanied by stable breathing patterns (Figs. 1 and 2). This finding was verified in a second polygraphy (Fig. 1). Transthoracic echocardiography revealed a marginal left ventricular hypertrophy and left ventricular diastolic dysfunction (ratio of early diastolic velocity to atrial velocity: e/a 85%). Holter-ECG and nocturnal capnometry remained without pathological findings.