Atrial Substrate and Triggers of Paroxysmal Atrial Fibrillation in Patients With Obstructive Sleep Apnea
Open accessAbstract
Background: Obstructive sleep apnea (OSA) is associated with atrial remodeling, atrial fibrillation (AF), and increased incidence of arrhythmia recurrence after pulmonary vein (PV) isolation. We aimed to characterize the atrial substrate, including AF triggers in patients with paroxysmal AF and OSA. Methods and Results: In 86 patients with paroxysmal AF (43 with ≥moderate OSA [apnea–hypopnea index ≥15] and 43 without OSA [apnea–hypopnea index <5]), right atrial and left atrial voltage distribution, conduction velocities, and electrogram characteristics were analyzed during atrial pacing. AF triggers were examined before and after PV isolation and targeted for ablation. Patients with OSA had lower atrial voltage amplitude (right atrial, P =0.0005; left atrial, P =0.0001), slower conduction velocities (right atrial, P =0.02; left atrial, P =0.0002), and higher prevalence of electrogram fractionation ( P =0.0001). The areas of atrial abnormality were consistent among patients, most commonly involving the left atrial septum (32/43; 74.4%). At baseline, the PVs were the most frequent triggers for AF in both groups; however, after PV isolation patients with OSA had increased incidence of additional extra-PV triggers (41.8% versus 11.6%; P =0.003). The 1-year arrhythmia-free survival was similar between patients with and without OSA (83.7% and 81.4%, respectively; P =0.59). In comparison, control patients with paroxysmal AF and OSA who underwent PV isolation alone without ablation on extra-PV triggers had increased risk of arrhythmia recurrence (83.7% versus 64.0%; P =0.003). Conclusions: OSA is associated with structural and functional atrial remodeling and increased incidence of extra-PV triggers. Elimination of these triggers resulted in improved arrhythmia-free survival.
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In general, patients with obstructive sleep apnea experienced a reduction in cardiac dysrhythmias when treated with CPAP.
“In general, patients with OSA experienced a reduction in cardiac dysrhythmias when treated with CPAP.24”
From Obstructive Sleep Apnea and Cardiovascular Disease: A Scientific Statement From the American Heart Association (2021) · cites this paper as [24]
The Discussion (page not supplied) says most observational studies associated CPAP use with reduced recurrence of atrial fibrillation in patients with OSA. That supports a narrower claim than a general reduction in cardiac dysrhythmias from CPAP treatment; the paper also cautions that the observational findings may not generalize and reports a randomized study that did not prevent new-onset AF. (LLM, conf=0.88)
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Cites
Kapur, V. K., Auckley, D. H., Chowdhuri, S., Kuhlmann, D. C., Mehra, R., Ramar, K., & Harrod, C. G. (2017) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.6506 · Cited by 3,253 · see citing works
CPAP for Prevention of Cardiovascular Events in Obstructive Sleep Apnea
McEvoy, R. D., Antic, N. A., Heeley, E., Luo, Y., Ou, Q., Zhang, X., Mediano, O., Chen, R., Drager, L. F., Liu, Z., et al. (2016) · New England Journal of Medicine · doi:10.1056/nejmoa1606599 · Cited by 2,101 · see citing works
Marrouche, N. F., Wilber, D., Hindricks, G., Jais, P., Akoum, N., Marchlinski, F., Kholmovski, E., Burgon, N., Hu, N., Mont, L., et al. (2014) · JAMA · doi:10.1001/jama.2014.3 · Cited by 1,473 · see citing works
Association of Atrial Fibrillation and Obstructive Sleep Apnea
Gami, A. S., Pressman, G., Caples, S. M., Kanagala, R., Gard, J. J., Davison, D. E., Malouf, J. F., Ammash, N. M., Friedman, P. A., & Somers, V. K. (2004) · Circulation · doi:10.1161/01.cir.0000136587.68725.8e · Cited by 1,148 · see citing works
Obstructive Sleep Apnea, Obesity, and the Risk of Incident Atrial Fibrillation
Gami, A. S., Hodge, D. O., Herges, R. M., Olson, E. J., Nykodym, J., Kara, T., & Somers, V. K. (2007) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2006.08.060 · Cited by 1,104 · see citing works
Obstructive Sleep Apnea and the Recurrence of Atrial Fibrillation
Kanagala, R., Murali, N. S., Friedman, P. A., Ammash, N. M., Gersh, B. J., Ballman, K. V., M. Shamsuzzaman, A. S., & Somers, V. K. (2003) · Circulation · doi:10.1161/01.cir.0000068337.25994.21 · Cited by 983 · see citing works
Pathak, R. K., Middeldorp, M. E., Lau, D. H., Mehta, A. B., Mahajan, R., Twomey, D., Alasady, M., Hanley, L., Antic, N. A., McEvoy, R. D., et al. (2014) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2014.09.028 · Cited by 949 · see citing works
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., et al. (2013) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2013.03.052 · Cited by 447 · see citing works
Self-citationAtrial remodeling in obstructive sleep apnea: Implications for atrial fibrillation
Dimitri, H. R., Ng, M., Brooks, A. G., Kuklik, P., Stiles, M. K., Lau, D. H., Antic, N. A., Thornton, A., Saint, D. A., McEvoy, R. D., et al. (2011) · Heart Rhythm · doi:10.1016/j.hrthm.2011.10.017 · Cited by 325 · see citing works
Naruse, Y., Tada, H., Satoh, M., Yanagihara, M., Tsuneoka, H., Hirata, Y., Ito, Y., Kuroki, K., Machino, T., Yamasaki, H., et al. (2013) · Heart Rhythm · doi:10.1016/j.hrthm.2012.11.015 · Cited by 267 · see citing works
de Jong, A. M., Maass, A. H., Oberdorf‐Maass, S. U., van Veldhuisen, D. J., van Gilst, W. H., & Gelder, I. C. V. (2010) · Cardiovascular Research · doi:10.1093/cvr/cvq357 · Cited by 266 · see citing works
Santangeli, P., Zado, E. S., Hutchinson, M. D., Riley, M. P., Lin, D., Frankel, D. S., Supple, G. E., Garcia, F. C., Dixit, S., Callans, D. J., et al. (2015) · Heart Rhythm · doi:10.1016/j.hrthm.2015.10.023 · Cited by 265 · see citing works
Linz, D., Schotten, U., Neuberger, H., Böhm, M., & WIRTH, K. J. (2011) · Heart Rhythm · doi:10.1016/j.hrthm.2011.03.053 · Cited by 250 · see citing works
Holmqvist, F., Guan, N., Zhu, Z., Kowey, P. R., Allen, L. A., Fonarow, G. C., Hylek, E. M., Mahaffey, K. W., Freeman, J. V., Chang, P., et al. (2015) · American Heart Journal · doi:10.1016/j.ahj.2014.12.024 · Cited by 249 · see citing works
Kottkamp, H., Berg, J., Bender, R., Rieger, A., & Schreiber, D. (2015) · Journal of Cardiovascular Electrophysiology · doi:10.1111/jce.12870 · Cited by 236 · see citing works
Patel, D., Mohanty, P., Di Biase, L., Shaheen, M., Lewis, W. R., Quan, K., Cummings, J. E., Wang, P., Al-Ahmad, A., Venkatraman, P., et al. (2010) · Circulation: Arrhythmia and Electrophysiology · doi:10.1161/circep.109.858381 · Cited by 234 · see citing works
Self-citationAnter, E., Tschabrunn, C. M., & Josephson, M. E. (2015) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.114.002737 · Cited by 224 · see citing works
Self-citationBody Mass Index, Obstructive Sleep Apnea, and Outcomes of Catheter Ablation of Atrial Fibrillation
JONGNARANGSIN, K., CHUGH, A., GOOD, E., MUKERJI, S., DEY, S., CRAWFORD, T., SARRAZIN, J. F., KUHNE, M., CHALFOUN, N., WELLS, D., et al. (2008) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.2008.01118.x · Cited by 219 · see citing works
Atrial Fibrillation Promotion With Long-Term Repetitive Obstructive Sleep Apnea in a Rat Model
Iwasaki, Y., Kato, T., Xiong, F., Shi, Y., Naud, P., Maguy, A., Mizuno, K., Tardif, J., Comtois, P., & Nattel, S. (2014) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2014.05.077 · Cited by 213 · see citing works
Neilan, T. G., Farhad, H., Dodson, J. A., Shah, R. V., Abbasi, S. A., Bakker, J. P., Michaud, G. F., van der Geest, R., Blankstein, R., Steigner, M., et al. (2013) · Journal of the American Heart Association · doi:10.1161/jaha.113.000421 · Cited by 158 · see citing works
Görenek, B., Pelliccia, A., Benjamin, E. J., Boriani, G., Crijns, H. J. G. M., Fogel, R. I., Gelder, I. C. V., Halle, M., Kudaiberdieva, G., Lane, D. A., et al. (2016) · EP Europace · doi:10.1093/europace/euw242 · Cited by 128 · see citing works
High-Resolution 3-Dimensional Reconstruction of the Infarct Border Zone
Rutherford, S. L., Trew, M. L., Sands, G. B., LeGrice, I. J., & Smaill, B. H. (2012) · Circulation Research · doi:10.1161/circresaha.111.260943 · Cited by 115 · see citing works
Morgan, R., Colman, M. A., Chubb, H., Seemann, G., & Aslanidi, O. V. (2016) · Frontiers in Physiology · doi:10.3389/fphys.2016.00474 · Cited by 104 · see citing works
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Yeghiazarians, Y., Jneid, H., Tietjens, J. R., Redline, S., Brown, D. L., El-Sherif, N., Mehra, R., Bozkurt, B., Ndumele, C. E., Somers, V. K., et al. (2021) · Circulation · doi:10.1161/cir.0000000000000988 · Cited by 1,431 · see citing works
Variability of Sleep Apnea Severity and Risk of Atrial Fibrillation
Linz, D., Brooks, A. G., Elliott, A. D., Nalliah, C. J., Hendriks, J. M. L., Middeldorp, M. E., Gallagher, C., Mahajan, R., Kalman, J. M., McEvoy, R. D., et al. (2019) · JACC: Clinical Electrophysiology · doi:10.1016/j.jacep.2019.03.005 · Cited by 110 · see citing works
How will machine learning inform the clinical care of atrial fibrillation?
Siontis, K. C., Yao, X., Pirruccello, J. P., Philippakis, A. A., & Noseworthy, P. A. (2020) · Circulation Research · doi:10.1161/circresaha.120.316401 · Cited by 61 · see citing works
Hojo, R., Fukamizu, S., Miyazawa, S., Kawamura, I., Sakurada, H., & Hiraoka, M. (2019) · Journal of Interventional Cardiac Electrophysiology · doi:10.1007/s10840-018-0489-x · Cited by 21 · see citing works
- Authors
- Anter, E., Di Biase, L., Contreras-Valdes, F. M., Gianni, C., Mohanty, S., Tschabrunn, C. M., Viles-Gonzalez, J. F., Leshem, E., Buxton, A. E., Kulbak, G., Halaby, R. N., Zimetbaum, P. J., Waks, J. W., Thomas, R. J., Natale, A., & Josephson, M. E.
- Affiliations
- Beth Israel Deaconess Medical Center (US)
- From the Cardiovascular Division, Department of Medicine, Harvard-Thorndike Electrophysiology Institute (E.A., F.M.C.-V., C.M.T., E.L., A.E.B., G.K., R.N.H., P.J.Z., J.W.W., M.E.J.) and Sleep Disorders Clinic, Departments of Medicine and Neurology (R.J.T.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin (L.D.B., C.G., S.M., A.N.); and Electrophysiology Section, Cardiovascular Division, University of...
- ORCID
- Venue
- Circulation: Arrhythmia and Electrophysiology
- Published
- 2017-11
- Volume
- 10
- Issue
- 11
- ISSN
- 1941-3084 (ISSN-L)
- 1941-3149
- PMC
- PMC5726812
- OpenAlex
- W2767459451
- Semantic Scholar
- 821d721e21308a87ae0e8f266639f9c2089a2a60
- Cited by
- 127
- References
- 23
- Citations by year
- 2026: 5 · 2025: 11 · 2024: 15 · 2023: 9 · 2022: 18 · 2021: 27 · 2020: 18 · 2019: 8 · 2018: 14 · 2017: 1
- FWCI
- 8.67
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Circulation Arrhythmia and Electrophysiology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Cineca Institutional Research Information System (Tor Vergata University) (submittedVersion)
- Funders
- Boston Scientific Corporation
- National Institutes of Health (5t32hl007374-41)
- National Heart, Lung, and Blood Institute (T32‐HL007374)
- 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, paroxysmal atrial fibrillation, atrial substrate, pulmonary vein isolation, atrial remodeling, atrial conduction velocity, electrogram fractionation, left atrial septum, arrhythmia recurrence, catheter ablation
- MeSH terms
- Action Potentials, Adult, Aged, Atrial Fibrillation, Female, Heart Rate, Humans, Male, Middle Aged, Pulmonary Veins, Recurrence, Risk Factors, Severity of Illness Index, Time Factors, United States, Treatment Outcome, Catheter Ablation, Disease-Free Survival, Sleep Apnea, Obstructive, Electrophysiologic Techniques, Cardiac, Kaplan-Meier Estimate, Atrial Remodeling
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