Key result
Unstable sleep before RFCA is linked to ~68% lower AF recurrence risk.
Why the study?
Sleep fragmentation and sleep apnea are common in AF, but the impact of RFCA on sleep quality and the effect of sleep quality changes on AF recurrence were unclear.
Does radio-frequency catheter ablation improve sleep quality, and does baseline sleep quality predict AF recurrence in patients with paroxysmal atrial fibrillation?
Cohort (n=225)
Does radio-frequency catheter ablation improve sleep quality, and does baseline sleep quality predict AF recurrence in patients with paroxysmal atrial fibrillation?
Radio-frequency catheter ablation improves sleep quality in patients with paroxysmal atrial fibrillation, and worse baseline sleep quality paradoxically predicts a lower risk of AF recurrence.
Answers are grounded in this paper and cite their sources.
Unstable pre-ablation sleep associated with lower AF recurrence; hypothesis-generating in this cohort and requires prospective validation before clinical use.
Background Sleep fragmentation and sleep apnea are common in patients with atrial fibrillation (AF). We investigated the impact of radio‐frequency catheter ablation (RFCA) on sleep quality in patients with paroxysmal AF and the effect of a change in sleep quality on recurrence of AF. Methods and Results Of 445 patients who underwent RFCA for paroxysmal AF between October 2007 and January 2017, we analyzed 225 patients who had a 24‐hour Holter test within 6 months before RFCA. Sleep quality was assessed by cardiopulmonary coupling analysis using 24‐hour Holter data. We compared cardiopulmonary coupling parameters (high‐frequency coupling, low‐frequency coupling, very‐low‐frequency coupling) before and after RFCA. Six months after RFCA, the high‐frequency coupling (marker of stable sleep) and very‐low‐frequency coupling (rapid eye movement/wake marker) was significantly increased (29.84%–36.15%; P <0.001; and 26.20%–28.76%; P =0.002, respectively) while low‐frequency coupling (unstable sleep marker) was decreased (41.25%–32.13%; P <0.001). We divided patients into 3 tertiles according to sleep quality before RFCA, and the risk of AF recurrence in each group was compared. The second tertile was used as a reference; patients with unstable sleep (Tertile 3) had a significantly lower risk of AF recurrence (hazard ratio [HR], 0.32; 95% CI, 0.12–0.83 for high‐frequency coupling; and HR, 0.22; 95% CI, 0.09–0.58 for low‐frequency coupling). Conclusions Sleep quality improved after RFCA in patients with paroxysmal AF. The recurrence rate was significantly lower in patients who had unstable sleep before RFCA. These results suggest that RFCA can influence sleep quality, and sleep quality assessment before RFCA may provide a risk marker for recurrence after RFCA in patients with paroxysmal AF.
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Kim et al. (2020) conducted a cohort in Paroxysmal atrial fibrillation (n=225). Unstable sleep before radio-frequency catheter ablation vs. Second tertile of sleep quality was evaluated on Atrial fibrillation recurrence (HR 0.32, 95% CI 0.12-0.83). Patients with unstable sleep before radio-frequency catheter ablation had a significantly lower risk of atrial fibrillation recurrence compared to the reference group (HR 0.32; 95% CI 0.12-0.83).
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