Treatment of Obstructive Sleep Apnea Reduces the Risk of Atrial Fibrillation Recurrence After Catheter Ablation
Open accessAbstract
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.
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Observational studies generally found that OSA patients not treated with CPAP are significantly more likely to have recurrent atrial fibrillation after electrical cardioversion or ablation than CPAP-treated patients, with two- to six-fold higher adjusted risk of recurrence.
“These studies have generally found that patients with OSA who are not treated with CPAP are significantly more likely to have recurrent AF than CPAP-treated patients, with two- to six-fold higher adjusted risk of recurrence.708,729,730,1215,1216”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [1215]
The Results report significantly more recurrence after ablation among CPAP nonusers than users with OSA, and the Effects of CPAP therapy section describes nonusers as more than twice as likely to recur. The adjusted model in Results, however, compares each OSA group with patients without OSA; it does not report a direct adjusted risk estimate for nonusers versus CPAP users. This paper also does not provide a sixfold estimate. (LLM, conf=0.84)
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- Authors
- Fein, A. S., Shvilkin, A., Shah, D., Haffajee, C. I., Das, S., Kumar, K., Kramer, D. B., Zimetbaum, P. J., Buxton, A. E., Josephson, M. E., & Anter, E.
- Affiliations
- Beth Israel Deaconess Medical Center (US)
- Corresponding author
- Anter, Elad
- ORCID
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2013-07
- Volume
- 62
- Issue
- 4
- Pages
- 300-305
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2093115827
- Semantic Scholar
- cecb3753fa862ecd4c306991327f9c40edd9bbdb
- Cited by
- 447
- References
- 26
- Citations by year
- 2026: 15 · 2025: 30 · 2024: 19 · 2023: 27 · 2022: 31 · 2021: 34 · 2020: 35 · 2019: 25 · 2018: 45 · 2017: 49 · 2016: 45 · 2015: 47 · 2014: 33 · 2013: 10 · 2012: 1
- FWCI
- 30.56
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Medtronic
- Biosense Webster and Rhythmia Medical
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Keywords
- obstructive sleep apnea, atrial fibrillation recurrence, continuous positive airway pressure, catheter ablation, pulmonary vein isolation, arrhythmia-free survival, antiarrhythmic drugs, repeat ablation, CPAP therapy
- MeSH terms
- Anti-Arrhythmia Agents, Atrial Fibrillation, Female, Follow-Up Studies, Humans, Male, Middle Aged, Prospective Studies, Recurrence, Risk Factors, Treatment Outcome, Catheter Ablation, Polysomnography, Sleep Apnea, Obstructive, Continuous Positive Airway Pressure
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