Safety and Efficacy of Pulmonary Vein Antral Isolation in Patients With Obstructive Sleep Apnea: The Impact of Continuous Positive Airway Pressure
Abstract
Background—: Obstructive sleep apnea (OSA) may be associated with pulmonary vein antrum isolation (PVAI) failure. The aim of the present study was to investigate if treatment with continuous positive airway pressure (CPAP) improved PVAI success rates. Methods and Results—: From January 2004 to December 2007, 3000 consecutive patients underwent PVAI. Patients were screened for OSA and CPAP use. Six hundred forty (21.3%) patients had OSA. Patients with OSA had more procedural failures ( P =0.024) and hematomas ( P <0.001). Eight percent of the non-OSA paroxysmal atrial fibrillation patients had nonpulmonary vein antrum triggers (non-PV triggers) and posterior wall firing versus 20% of the OSA group ( P <0.001). Nineteen percent of the non-OSA nonparoxysmal atrial fibrillation population had non-PV triggers versus 31% in the OSA group ( P =0.001). At the end of the follow-up period (32±14 months), 79% of the non-CPAP and 68% of the CPAP group were free of atrial fibrillation ( P =0.003). Not using CPAP in addition to having non-PV triggers strongly predicted procedural failure (hazard ratio, 8.81; P <0.001). Conclusions—: OSA was an independent predictor for PVAI failure. Treatment with CPAP improved PVAI success rates. Patients not treated with CPAP in addition to having higher prevalence of non-PV triggers were 8 times more likely to fail the procedure.
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A similar increased risk of atrial fibrillation recurrence was reported in several studies that did not systematically screen for OSA, comparing patients with a documented prior OSA diagnosis to those without known OSA.
“A similar increased risk of AF recurrence was reported in several studies that did not systematically screen for OSA, but compared the risk of AF recurrence following ablation procedures in patients with a documented prior diagnosis of OSA to those without known OSA.728–730”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [730]
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 [730]
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References 25 · Cited by 234
- Authors
- Patel, D., Mohanty, P., Di Biase, L., Shaheen, M., Lewis, W. R., Quan, K., Cummings, J. E., Wang, P., Al-Ahmad, A., Venkatraman, P., Nashawati, E., Lakkireddy, D., Schweikert, R., Horton, R., Sanchez, J., Gallinghouse, J., Hao, S., Beheiry, S., Cardinal, D. S., Zagrodzky, J., Canby, R., Bailey, S., Burkhardt, J. D., & Natale, A.
- Affiliations
- University of Foggia (IT)
- From St David's Medical Center and Texas Cardiac Arrhythmia Center (D.P., P.M., L.D.B., P.V., R.H., J.S., J.G., D.S.C., J.Z., R.C., S.B., J.D.B., A.N.), Austin, Tex; Akron General Hospital (J.E.C., R.S.), Akron, Ohio; Stanford University (P.W., A.A.-A.), Palo Alto, Calif; Metro Health Hospital (W.R.L., K.Q.), Case Western Reserve, Cleveland, Ohio; California Pacific Medical Center (S.H., S.B.), San Francisco, Calif; Kansas University (D.L.), Lawrence, Kan; the University of Cincinnati (M.S., E.N.),...
- ORCID
- Venue
- Circulation: Arrhythmia and Electrophysiology
- Published
- 2010-10
- Volume
- 3
- Issue
- 5
- Pages
- 445-451
- ISSN
- 1941-3084 (ISSN-L)
- 1941-3149
- OpenAlex
- W2118251699
- Semantic Scholar
- 256895c2c9047d9f6634bc137e4b32c2d95eff45
- Cited by
- 234
- References
- 25
- Citations by year
- 2026: 3 · 2025: 10 · 2024: 12 · 2023: 11 · 2022: 12 · 2021: 15 · 2020: 14 · 2019: 8 · 2018: 24 · 2017: 22 · 2016: 10 · 2015: 24 · 2014: 18 · 2013: 20 · 2012: 21
- FWCI
- 10.75
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation Arrhythmia and Electrophysiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Sanofi
- Boston Scientific Corporation
- LifeWatch – Niclas Öberg Foundation
- Biosense Webster
- 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
- obstructive sleep apnea, pulmonary vein antrum isolation, catheter ablation, paroxysmal atrial fibrillation, continuous positive airway pressure, procedural failure, atrial fibrillation recurrence
- MeSH terms
- Atrial Fibrillation, Female, Follow-Up Studies, Heart Conduction System, Heart Rate, Humans, Male, Middle Aged, Pulmonary Veins, Retrospective Studies, Time Factors, Treatment Outcome, Catheter Ablation, Sleep Apnea, Obstructive, Continuous Positive Airway Pressure
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