Key result
Parasympathetic hyperactivity links to post-ablation AF recurrence but is offset during sleep apnea.
Why the study?
The impact of sleep apnea on heart rate variability in patients with atrial fibrillation had not been investigated.
Does sleep apnea alter nocturnal parasympathetic activity (measured by HRV) in patients with atrial fibrillation after catheter ablation?
Observational (n=76)
No
Does sleep apnea alter nocturnal parasympathetic activity (measured by HRV) in patients with atrial fibrillation after catheter ablation?
Absolute Event Rate: 20.9% vs 15.5%
p-value: p=<0.01
Sleep apnea suppresses nocturnal parasympathetic hyperactivity in patients with atrial fibrillation recurrence, suggesting that nocturnal HRV analysis for predicting AF recurrence may be misinterpreted if sleep apnea is not accounted for.
Sleep apnea may confound nocturnal HRV assessment of post-ablation AF recurrence risk; leaves open whether apnea treatment modifies outcomes.
BACKGROUND: The impact of sleep apnea (SA) on heart rate variability (HRV) in atrial fibrillation (AF) patients has not been investigated. METHODS AND RESULTS: Of 94 patients who underwent AF ablation between January 2021 and September 2022, 76 patients who had a nocturnal Holter electrocardiography and polysomnography conducted simultaneously were included in the analysis. A 15-min duration of HRV, as determined by an electrocardiogram during apnea and non-apnea time, were compared between patients with and without AF recurrence at 12 months' postoperatively. Patients had a mean age of 63.4±11.6 years, 14 were female, and 20 had AF recurrence at 12 months' follow-up. The root mean square of the difference between consecutive normal-to-normal intervals (RMSSD, ms) an indicator of a parasympathetic nervous system, was more highly increased in patients with AF recurrence than those without, during both apnea and non-apnea time (apnea time: 16.7±4.5 vs. 13.5±3.3, P=0.03; non-apnea time: 20.9±9.5 vs. 15.5±5.9, P<0.01). However, RMSSD during an apneic state was decreased more than that in a non-apneic state in both groups of patients with and without AF recurrence (AF recurrence group: 16.7±4.5 vs. 20.9±9.5, P<0.01; non-AF recurrence group; 13.5±3.3 vs. 15.5±5.9, P=0.03). Consequently, the effect of AF recurrence on parasympathetic activity was offset by SA. Similar trends were observed for other parasympathetic activity indices; high frequency (HF), logarithm of HF (lnHF) and the percentage of normal-to-normal intervals >50 ms (pNN50). CONCLUSIONS: Without considering the influence of SA, the results of nocturnal HRV analysis might be misinterpreted. Caution should be taken when using nocturnal HRV as a predictor of AF recurrence.
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Iwakoshi et al. (2024) conducted an observational in Atrial Fibrillation (n=76). AF recurrence vs. Non-AF recurrence was evaluated on RMSSD during non-apnea time (p=<0.01). In patients with atrial fibrillation after catheter ablation, parasympathetic hyperactivity associated with AF recurrence (RMSSD 20.9 vs 15.5 ms) was offset during sleep apnea periods.
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