June 5, 2014Journal of Cardiovascular Electrophysiology
Long‐Term Outcome of Catheter Ablation in Atrial Fibrillation Patients with Coexistent Metabolic Syndrome and Obstructive Sleep Apnea: Impact of Repeat Procedures versus Lifestyle Changes
Key result
Coexistent metabolic syndrome and sleep apnea increased AF recurrence after ablation (52% vs 34%, P<0.001); for recurrences, repeat ablation and lifestyle changes yielded similar outcomes (76% vs 74%).
Why the study?
Does repeat ablation or lifestyle modification prevent arrhythmia recurrence in AF patients experiencing recurrence after a first catheter ablation?
Population
1,257 atrial fibrillation patients undergoing first catheter ablation. Group 1 had coexistent metabolic…
Comparison
First catheter ablation. For patients… vs Comparison of outcomes between patients with…
Design
Cohort
Follow-up
34 ± 8 months, 20 ± 6 months
Authors
Discussion
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Implication
Metabolic syndrome plus sleep apnea may raise post-ablation AF recurrence; leaves open whether lifestyle modification matches repeat ablation for recurrences.
Study Design
Type
Cohort (n=1,257)
Structured PICO
Does repeat ablation or lifestyle modification prevent arrhythmia recurrence in AF patients experiencing recurrence after a first catheter ablation?
P
Population
1,257 atrial fibrillation patients undergoing first catheter ablation, followed for a mean of 34 months to evaluate the impact of metabolic syndrome and obstructive sleep apnea on recurrence.
E
Exposure
First catheter ablation. For patients experiencing recurrence, management consisted of either repeat ablation (for persistent arrhythmia) or aggressive lifestyle modifications (LSM) and previously ineffective antiarrhythmic drugs (AAD) (for sporadic events).
C
Comparator
Comparison of outcomes between patients with MS+OSA versus those with lone MS, lone OSA, or neither. For recurrences, comparison between repeat ablation and LSM+AAD.
O
Outcome
Arrhythmia recurrence after first procedure (at 34 ± 8 months) and freedom from recurrence after redo-ablation or LSM (at 20 ± 6 months).
Main Result
Absolute Event Rate: 52% vs 34%
p-value: p=< 0.001
Coexistent metabolic syndrome and obstructive sleep apnea additively increase AF recurrence after catheter ablation, but aggressive lifestyle modifications can achieve similar long-term rhythm control as repeat ablation in patients with recurrences.
Cite This Study
Mohanty et al. (2014) conducted a cohort in Atrial Fibrillation (n=1,257). Coexistent metabolic syndrome and obstructive sleep apnea vs. Metabolic syndrome alone, obstructive sleep apnea alone, or neither was evaluated on Arrhythmia recurrence after first procedure (p=< 0.001). Coexistent metabolic syndrome and sleep apnea increased AF recurrence after ablation (52% vs 34%, P<0.001); for recurrences, repeat ablation and lifestyle changes yielded similar outcomes (76% vs 74%).