Association between sinus rhythm restoration and sleep-disordered breathing at three months after pulmonary vein isolation for persistent atrial fibrillation

BACKGROUND: Sleep-Disordered Breathing (SDB) is common in patients with Atrial Fibrillation (AF), and its treatment reduces AF recurrence after Pulmonary Vein Isolation (PVI). However, the mid-term impact of sinus rhythm restoration on SDB remains unclear. METHODS AND RESULTS: The authors retrospectively analyzed 41 patients (mean age 68 ± 9 years; 36 men) with persistent AF who underwent PVI. Apnea-Hypopnea Index (AHI) was measured before and 3-months after PVI using type 3 polysomnography. At 3-months post-PVI, median AHI significantly decreased from 31.0 (Interquartile Range [IQR] 16.3-43.3) to 22.0 ([IQR 12.9-35.4]; p = 0.011). Sixty-eight percent of patients showed reduced SDB severity, and 39% of patients showed clinical AHI improvement. Preoperative left ventricular ejection fraction measured by echocardiography (Odds Ratio 1.182, 95% Confidence Interval 1.029-1.357) was independently associated with improved AHI. During a median follow-up of 12.9 months, AF recurrence was significantly lower in the AHI-improved group (log-rank p = 0.048). CONCLUSION: The findings of this study indicate that the sinus restoration achieved by PVI for persistent AF is associated with a reduction in the AHI compared to the preoperative levels. Assessing SDB after PVI under sinus rhythm may be important for comprehensive AF management.