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High prevalence of obstructive sleep apnea in patients with resistant paroxysmal atrial fibrillation after pulmonary vein isolation

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Abstract

Objectives

To address the question whether obstructive sleep apnea (OSA) is associated with the recurrence of paroxysmal atrial fibrillation (AF) in patients treated with ≥2 pulmonary vein isolation procedures.

Patients and Methods

In this study, we included adults with therapy-resistant symptomatic paroxysmal AF, defined as AF recurring after ≥2 PV-isolation procedures (n = 23). For comparison, we selected another cohort of patients being successfully treated by one PV isolation without AF recurrence within 6 months (n = 23). PV isolation was performed by radiofrequency with an open irrigated tip catheter. Each of the 46 participants completed an overnight polygraphic study. The two groups were matched for age, gender, and ejection fraction. Patients were late middle-aged (65 ± 7 vs 63 ± 10 years, P = 0.23), white (100%), and overweight (BMI 27.3 ± 3.6 vs. 27.2 ± 4.6 kg/m2, P = 0.97).

Results

The prevalence of sleep apnea, defined as an apnea–hypopnea index (AHI) of >5 per hour of sleep, was 87% in patients with therapy-resistant AF compared to 48% in the control cohort (P = 0.005). In addition, OSA was more severe in the resistant AF group indicated by a significantly higher AHI (27 ± 22 vs 12 ± 16, P = 0.01).

Conclusion

The extraordinarily high prevalence of sleep apnea in patients with recurrent paroxysmal AF supports its presumable role in the pathogenesis of AF and demands further controlled prospective trials. Moreover, OSA should inherently be considered in patients with therapy-resistant AF.

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References

  1. Fuster, V., et al. (2006). ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation, 114(7), e257–e354.

    Article  PubMed  Google Scholar 

  2. Go, A. S., et al. (2001). Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. Jama, 285(18), 2370–2375.

    Article  CAS  PubMed  Google Scholar 

  3. Lloyd-Jones, D. M., et al. (2004). Lifetime risk for development of atrial fibrillation: the Framingham Heart Study. Circulation, 110(9), 1042–1046.

    Article  PubMed  Google Scholar 

  4. Benjamin, E. J., et al. (1998). Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation, 98(10), 946–952.

    CAS  PubMed  Google Scholar 

  5. Gami, A. S., et al. (2004). Association of atrial fibrillation and obstructive sleep apnea. Circulation, 110(4), 364–367.

    Article  PubMed  Google Scholar 

  6. Haissaguerre, M., et al. (1998). Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. The New England Journal of Medicine, 339(10), 659–666.

    Article  CAS  PubMed  Google Scholar 

  7. Pappone, C., et al. (2001). Atrial electroanatomic remodeling after circumferential radiofrequency pulmonary vein ablation: efficacy of an anatomic approach in a large cohort of patients with atrial fibrillation. Circulation, 104(21), 2539–2544.

    Article  CAS  PubMed  Google Scholar 

  8. Cappato, R., et al. (2005). Worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circulation, 111(9), 1100–1105.

    Article  PubMed  Google Scholar 

  9. Bertaglia, E., et al. (2003). Circumferential isolation of pulmonary veins with transcatheter radiofrequency ablation in the treatment of atrial fibrillation. Italian Heart Journal. Supplement, 4(10), 825–832.

    Google Scholar 

  10. Ernst, S., et al. (2003). Catheter-induced linear lesions in the left atrium in patients with atrial fibrillation: an electroanatomic study. Journal of the American College of Cardiology, 42(7), 1271–1282.

    Article  PubMed  Google Scholar 

  11. Linhart, M., et al. (2009). Comparison of Cryoballoon and Radiofrequency Ablation of Pulmonary Veins in 40 Patients with Paroxysmal Atrial Fibrillation: A Case-Control Study. Journal of Cardiovascular Electrophysiology.

  12. Johns, M. W. (1991). A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep, 14(6), 540–545.

    CAS  PubMed  Google Scholar 

  13. Malone, S., et al. (1991). Obstructive sleep apnoea in patients with dilated cardiomyopathy: effects of continuous positive airway pressure. Lancet, 338(8781), 1480–1484.

    Article  CAS  PubMed  Google Scholar 

  14. Somers, V. K., et al. (2008). Sleep apnea and cardiovascular disease: an American Heart Association/american College Of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council On Cardiovascular Nursing. In collaboration with the National Heart, Lung, and Blood Institute National Center on Sleep Disorders Research (National Institutes of Health). Circulation, 118(10), 1080–1111.

    Article  PubMed  Google Scholar 

  15. Ruehland, W. R., et al. (2009). The new AASM criteria for scoring hypopneas: impact on the apnea hypopnea index. Sleep, 32(2), 150–157.

    PubMed  Google Scholar 

  16. Kanagala, R., et al. (2003). Obstructive sleep apnea and the recurrence of atrial fibrillation. Circulation, 107(20), 2589–2594.

    PubMed  Google Scholar 

  17. Jongnarangsin, K., et al. (2008). Body mass index, obstructive sleep apnea, and outcomes of catheter ablation of atrial fibrillation. Journal of Cardiovascular Electrophysiology, 19(7), 668–672.

    Article  PubMed  Google Scholar 

  18. Lavie, P., Ben-Yosef, R., & Rubin, A. E. (1984). Prevalence of sleep apnea syndrome among patients with essential hypertension. American Heart Journal, 108(2), 373–376.

    Article  CAS  PubMed  Google Scholar 

  19. Jelic, S., et al. (2008). Inflammation, oxidative stress, and repair capacity of the vascular endothelium in obstructive sleep apnea. Circulation, 117(17), 2270–2278.

    Article  CAS  PubMed  Google Scholar 

  20. Bode, F., et al. (2000). Gadolinium decreases stretch-induced vulnerability to atrial fibrillation. Circulation, 101(18), 2200–2205.

    CAS  PubMed  Google Scholar 

  21. Jais, P., et al. (2000). Left ventricular diastolic dysfunction in patients with so-called lone atrial fibrillation. Journal of Cardiovascular Electrophysiology, 11(6), 623–625.

    Article  CAS  PubMed  Google Scholar 

  22. Sauer, W. H., et al. (2006). Clinical predictors and outcomes associated with acute return of pulmonary vein conduction during pulmonary vein isolation for treatment of atrial fibrillation. Heart Rhythm, 3(9), 1024–1028.

    Article  PubMed  Google Scholar 

  23. Gami, A. S., et al. (2007). Obstructive sleep apnea, obesity, and the risk of incident atrial fibrillation. Journal of the American College of Cardiology, 49(5), 565–571.

    Article  PubMed  Google Scholar 

  24. Tanigawa, T., et al. (2006). Arterial oxygen desaturation during sleep and atrial fibrillation. Heart, 92(12), 1854–1855.

    Article  CAS  PubMed  Google Scholar 

  25. Chilukuri, K., et al. (2009). Predictive value of obstructive sleep apnoea assessed by the Berlin Questionnaire for outcomes after the catheter ablation of atrial fibrillation. Europace, 11(7), 896–901.

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors gratefully acknowledge the expert technical assistance of Karin Springmann.

Disclosures

The authors confirm that there are no conflicts of interest.

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Authors and Affiliations

  1. From the Department of Internal Medicine II—Cardiology, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany

    Friedrich Felix Hoyer, Lars Martin Lickfett, Erica Mittmann-Braun, Charlotte Ruland, Jens Kreuz, Stefan Pabst, Jan Schrickel, Uwe Juergens, Georg Nickenig & Dirk Skowasch

  2. Department of Internal Medicine, Franziskus-Hospital Linz/Rein, Linz am Rhein, Germany

    Selcuk Tasci

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  1. Friedrich Felix Hoyer
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  2. Lars Martin Lickfett
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  3. Erica Mittmann-Braun
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  4. Charlotte Ruland
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  5. Jens Kreuz
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  6. Stefan Pabst
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  7. Jan Schrickel
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  9. Selcuk Tasci
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  10. Georg Nickenig
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  11. Dirk Skowasch
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Correspondence to Friedrich Felix Hoyer.

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Hoyer, F.F., Lickfett, L.M., Mittmann-Braun, E. et al. High prevalence of obstructive sleep apnea in patients with resistant paroxysmal atrial fibrillation after pulmonary vein isolation. J Interv Card Electrophysiol 29, 37–41 (2010). https://doi.org/10.1007/s10840-010-9502-8

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  • DOI: https://doi.org/10.1007/s10840-010-9502-8

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