Treatment of Obstructive Sleep Apnea Reduces the Risk of Atrial Fibrillation Recurrence After Catheter Ablation
Key result
CPAP therapy is linked to ~56% lower AF recurrence at 12 months post-PVI.
- P=0.01
- n=62
Why the study?
OSA predicts AF recurrence after PVI, but the impact of CPAP therapy on PVI outcomes in patients with OSA is poorly known.
Does continuous positive airway pressure (CPAP) therapy reduce atrial fibrillation recurrence in patients with obstructive sleep apnea undergoing pulmonary vein isolation?
Key Points
- To assess the effect of continuous positive airway pressure (CPAP) therapy on atrial fibrillation (AF) recurrence in patients with obstructive sleep apnea (OSA) undergoing pulmonary vein isolation (PVI).
- Analyzed 62 patients with polysomnography-confirmed OSA (32 CPAP users, 30 nonusers) out of 426 patients who underwent PVI between 2007 and 2010.
- Tracked AF recurrence, antiarrhythmic drug use, and repeat ablations over a 12-month follow-up, comparing outcomes between CPAP groups and against patients without OSA.
- CPAP users achieved a significantly higher AF-free survival rate (71.9% vs. 36.7%; p = 0.01) and AF-free survival off antiarrhythmic drugs or repeat ablation (65.6% vs. 33.3%; p = 0.02) compared to nonusers.
- CPAP nonusers experienced significantly increased AF recurrence risk (HR: 2.4, p < 0.02), whereas CPAP users had recurrence rates comparable to patients without OSA (HR: 0.7, p = 0.46).
Study Design
Type
Cohort (n=62)
Structured PICO
Does continuous positive airway pressure (CPAP) therapy reduce atrial fibrillation recurrence in patients with obstructive sleep apnea undergoing pulmonary vein isolation?
P
Population
62 patients with polysomnography-confirmed obstructive sleep apnea undergoing pulmonary vein isolation, followed for 12 months.
E
Exposure
Continuous positive airway pressure (CPAP) therapy (n=32)
C
Comparator
No CPAP therapy (CPAP nonusers, n=30)
O
Outcome
Recurrence of any atrial tachyarrhythmia during a follow-up period of 12 monthshard clinical
Main Result
Absolute Event Rate: 71.9% vs 36.7%
p-value: p=0.01
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Our study confirms the expanding body of evidence that treatment of modifiable risk factors has a significant impact on the long-term suppression of atrial fibrillation regardless of the type of therapy offered. Active screening for obstructive sleep apnea in all patients who undergo treatment for atrial fibrillation is imperative as the use of CPAP will influence the outcome of therapy and likely reduce some of the cardiovascular morbidity associated with atrial fibrillation.”
“Sleep apnea, along with several other conditions including hypertension, obesity, and diabetes, actively contribute to the onset and progression of atrial fibrillation. This study provides important evidence that we need to identify and treat these associated conditions if our more direct efforts to suppress the arrhythmia by antiarrhythmic drugs or ablation are to be effective.”
MCMina ChungStaff cardiologist, Cleveland Clinic Electrophysiology
“Currently there are only small or limited randomized studies that have addressed SDB and atrial fibrillation, and they have shown conflicting results.”
Implication
CPAP therapy significantly improves arrhythmia-free survival in patients with obstructive sleep apnea undergoing pulmonary vein isolation for atrial fibrillation.
Abstract
OBJECTIVES: The aim of this study was to examine the effect of continuous positive airway pressure (CPAP) therapy on atrial fibrillation (AF) recurrence in patients with obstructive sleep apnea (OSA) undergoing pulmonary vein isolation (PVI). BACKGROUND: OSA is a predictor of AF recurrence following PVI. However, the impact of CPAP therapy on PVI outcome in patients with OSA is poorly known. METHODS: Among 426 patients who underwent PVI between 2007 and 2010, 62 patients had a polysomnography-confirmed diagnosis of OSA. While 32 patients were "CPAP users" the remaining 30 patients were "CPAP nonusers." The recurrence of any atrial tachyarrhythmia, use of antiarrhythmic drugs, and need for repeat ablations were compared between the groups during a follow-up period of 12 months. Additionally, the outcome of patients with OSA was compared to a group of patients from the same PVI cohort without OSA. RESULTS: CPAP therapy resulted in higher AF-free survival rate (71.9% vs. 36.7%; p = 0.01) and AF-free survival off antiarrhythmic drugs or repeat ablation following PVI (65.6% vs. 33.3%; p = 0.02). AF recurrence rate of CPAP-treated patients was similar to a group of patients without OSA (HR: 0.7, p = 0.46). AF recurrence following PVI in CPAP nonuser patients was significantly higher (HR: 2.4, p < 0.02) and similar to that of OSA patients managed medically without ablation (HR: 2.1, p = 0.68). CONCLUSIONS: CPAP is an important therapy in OSA patients undergoing PVI that improves arrhythmia free survival. PVI offers limited value to OSA patients not treated with CPAP.
Discussion
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Cite This Study
Fein et al. (2013) conducted a cohort in Obstructive sleep apnea and atrial fibrillation (n=62). Continuous positive airway pressure (CPAP) therapy vs. CPAP nonusers was evaluated on Atrial fibrillation-free survival rate (p=0.01). CPAP therapy in patients with obstructive sleep apnea undergoing pulmonary vein isolation resulted in a higher 12-month AF-free survival rate compared to CPAP nonusers (71.9% vs. 36.7%; p=0.01).