Prevalence and risk factors of atrial fibrillation-Collective of the SERVE-HF Major Substudy

Abstract

<b>Aim:</b> Central sleep apnea (CSA) could trigger atrial fibrillation (AF) due to the associated intermittent hypoxia, recurrent arousals, intrathoracic pressure differences and sympathetic activation in patients with heart failure and reduced ejection fraction (HFrEF). The aim of the present work was to analyse the prevalence and risk factors of AF in patients with CSA and HFrEF. <b>Methods:</b> In the SERVE-HF Major substudy (NCT01164592) 312 patients were included. Polysomnography including a nocturnal electrocardiogram was available at baseline (n=272) and after 3 months (n=180). After exclusion of patients with pacemakers, 110 patients were analysed for AF. <b>Results:</b> The prevalence of AF at baseline was 39%. Patients with AF were older (72 vs. 67years, p=0.005), more often assigned to NYHA 3 and 4 (84 vs. 64%, p=0.026) and had a higher mean heart rate (HFm;75 vs. 67/min, p=0.006) and blood pressure (systolic 135 vs. 124mmHg, p=0.004; diastolic 79 vs. 74mmHg, p=0.025). In univariate regression analysis, established risk factors (RF) such as age, higher RRsys and diastolic blood pressure, NYHA 3 and 4, and mean heart rate, were associated with AF. In contrast to apnea-hypopnea (odds ratio [OR]: 1.009; 95% confidence interval [95% CI]: 0.984-1.035; p=0.478) and hypopnea index (HI;OR: 0.969; 95% CI: 0.936-1.003; p=0.077), apnea index (AI;OR: 1.024; 95% CI: 1.001-1.046; p=0.039) was identified as a RF. After adjustment for RRsys, HFm and AI, RRsys and HFm were associated with AF, but AI was not. <b>Conclusion:</b> The prevalence of AF in these patients is 39%.&nbsp;In addition to known RF, AI was associated with AF,&nbsp;in contrast to the HI. The results suggest that more severe forms of CSA are associated with AF.