Long-term outcome of catheter ablation in atrial fibrillation patients with coexistent metabolic syndrome and obstructive sleep apnea: impact of repeat procedures versus lifestyle changes
Abstract
INTRODUCTION: Metabolic syndrome (MS) and obstructive sleep apnea (OSA) are well-known independent risk factors for atrial fibrillation (AF) recurrence. This study evaluated ablation outcome in AF patients with coexistent MS and OSA and influence of lifestyle modifications (LSM) on arrhythmia recurrence. METHODS AND RESULTS: We included 1,257 AF patients undergoing first catheter ablation (30% paroxysmal AF). Patients having MS + OSA were classified into Group 1 (n = 126; 64 ± 8 years; 76% male). Group 2 (n = 1,131; 62 ± 11 years; 72% male) included those with either MS (n = 431) or OSA (n = 112; no CPAP users) or neither of these comorbidities (n = 588). Patients experiencing recurrence after first procedure were divided into 2 subgroups; those having sporadic events (frequency < 2 months) remained on previously ineffective antiarrhythmic drugs (AAD) and aggressive LSM, while those with persistent arrhythmia (incessant or ≥2 months) underwent repeat ablation. After 34 ± 8 months of first procedure, 66 (52%) in Group 1 and 386 (34%) in Group 2 had recurrence (P < 0.001). Recurrence rate in only-MS, only-OSA, and without MS/OSA groups were 40%, 38%, and 29%, respectively. Patients with MS + OSA experienced substantially higher recurrence compared to those with lone MS or OSA (52% vs. 40% vs. 38%; P = 0.036). Of the 452 patients having recurrence, 250 underwent redo-ablation and 194 remained on AAD and LSM. At 20 ± 6 months, 76% of the redo group remained arrhythmia-free off AAD whereas 74% of the LSM group were free from recurrence (P = 0.71), 33% of which were off AAD. CONCLUSIONS: MS and OSA have additive negative effect on arrhythmia recurrence following single procedure. Repeat ablation or compliant LSM increase freedom from recurrent AF.
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Atrial fibrillation occurs at a high incidence after cavotricuspid isthmus ablation for typical atrial flutter.
“Given the high incidence of AF after CTI ablation for typical AFL”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [165]
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- Authors
- MOHANTY, S., MOHANTY, P., DI BIASE, L., BAI, R., TRIVEDI, C., SANTANGELI, P., SANTORO, F., HONGO, R., HAO, S., BEHEIRY, S., BURKHARDT, D., GALLINGHOUSE, J. G., HORTON, R., SANCHEZ, J. E., BAILEY, S., HRANITZKY, P. M., ZAGRODZKY, J., & NATALE, A.
- Affiliations
- St David's Medical Center (US)
- Texas Cardiac Arrhythmia Institute St. David's Medical Center Austin Texas USA
- Capital Medical University (CN)
- University of Foggia (IT)
- California Pacific Medical Center (US)
- Corresponding author
- NATALE, ANDREA
- ORCID
- Venue
- Journal of Cardiovascular Electrophysiology
- Publisher
- Wiley
- Published
- 2014-07-04
- Volume
- 25
- Issue
- 9
- Pages
- 930-938
- ISSN
- 1045-3873 (ISSN-L)
- 1540-8167
- OpenAlex
- W2137996939
- Cited by
- 46
- References
- 39
- Citations by year
- 2026: 2 · 2024: 1 · 2023: 4 · 2022: 3 · 2021: 7 · 2020: 6 · 2019: 2 · 2018: 4 · 2017: 6 · 2016: 8 · 2015: 1 · 2014: 2
- FWCI
- 3.89
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Cardiovascular Electrophysiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Keywords
- atrial fibrillation, catheter ablation, metabolic syndrome, obstructive sleep apnea, arrhythmia recurrence, repeat ablation, lifestyle modification, antiarrhythmic drugs, comorbidities
- MeSH terms
- Atrial Fibrillation, Female, Humans, Life Style, Male, Middle Aged, Prospective Studies, Recurrence, Reoperation, Time Factors, Treatment Outcome, Catheter Ablation, Sleep Apnea, Obstructive, Metabolic Syndrome
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