0998 Don’t Sleep on Atrial Fibrillation Triggers

Abstract Introduction The remede system (Respicardia Inc., Minnetonka, MN, USA) is FDA-approved for the treatment of moderate to severe central sleep apnea (CSA) in patients with cardiovascular disease. However, whether treating CSA can reduce atrial fibrillation (AF) burden remains uncertain. Notably, randomized trials targeting obstructive sleep apnea have not demonstrated reductions in AF burden Methods We report a case of severe CSA, heart failure with reduced ejection fraction (HFrEF), and persistent AF refractory to extensive rhythm-control therapy, in which effective CSA treatment and led to resolution of AF. Results An 81-year-old man with HFrEF, persistent AF, coronary artery disease, hypertension, diabetes, and a cardiac resynchronization device presented with severe daytime sleepiness. His AF had been resistant to pulmonary vein isolation, dofetilide, and amiodarone, and he ultimately required AV node ablation. Home sleep study showed severe CSA with an AHI of 62 (3 obstructive apneas, 235 central apneas, 48 hypopneas). He underwent placement of a left phrenic nerve stimulator without complications ( See Figure 1A), but later required lead extraction and replacement on the right side due to dislodgement. ( See Figure 1B) After optimizing phrenic nerve stimulation in April 2024, repeat polysomnography showed improvement with an AHI of 22.6 (1 obstructive apnea, 24 central apneas, 79 hypopneas) (See Figure 1E). The patient reported increased energy and resolution of his sleepiness. Notably, his AF burden dropped from 100% before therapy to 0.1% over 20 months of follow-up. (See Figure 1C and 1D) Conclusion This case demonstrates resolution of persistent AF in a patient with severe CSA who had previously failed multiple rhythm-control strategies. Given the complex interplay between CSA and HF, effective treatment in severe central sleep apnea may reduce AF burden in certain patients. Awareness and further studies are necessary Support (if any)