Predictors of recurrence in patients undergoing cryoballoon ablation for treatment of atrial fibrillation: The independent role of sleep disordered breathing

Introduction: In patients with atrial fibrillation (AF) undergoing pulmonary vein isolation, cryoballoon technique (cryoPVI) has been adopted in many centers. This study aimed to evaluate predictors of AF recurrence including impact of sleep disordered breathing (SDB). Methods: In 82 patients consecutively assigned to cryoPVI cardiorespiratory screening for SDB, assessment of medical history, ECG, echocardiography, standard laboratory measurement, and blood gas analysis were performed prior to intervention. After 3 months blanking period 7-days Holter ECG was performed at 3, 6 and then every 6 months to determine AF recurrence. Results: 75 patients (69 paroxysmal AF, 6 persistent AF, 22 female, age 60±9 years) completed at least 6 month follow-up. Median follow-up of 12 months (interquartile range 6 to 18 months) confirmed maintenance of sinus rhythm in 69.4% of these patients. Stepwise forward regression model revealed moderate to severe SDB (cut-off apnea-hypopnea-index (AHI) ≥ 15/h; Hazard Ratio (HR) 2.95, p=0.04), early recurrence of atrial fibrillation (HR 8.74, p<0.001), persistent atrial fibrillation (HR 7.16, p<0.001), pre-procedural class III-antiarrhythmic drug treatment (HR 3.63, p=0.02), but not SDB per se (AHI ≥5/h) as independent predictors for AF recurrence. Conclusion: Moderate to severe SDB is a treatable condition that independently predicts AF recurrence in patients undergoing cryoPVI. Screening for SDB and adequate treatment may improve long-term success of cryoPVI.