Pulmonary vein isolation in patients with obstructive sleep apnea

Atrial fibrillation (AF) affects 2%–4% of adults. It reduces quality of life (QoL) and is associated with an increased risk of heart failure, stroke, and mortality. Antiarrhythmic drugs have moderate efficacy and possible bothersome side effects. Catheter ablation with pulmonary vein isolation (PVI) has been increasingly used in the past 2 decades to reduce AF symptoms and reduce the need for antiarrhythmic drugs.

AF and obstructive sleep apnea (OSA) frequently coexist, and the presence and severity of OSA are independently associated with the burden of AF. It has been suggested that treatment of OSA with continuous positive airway pressure (CPAP) may reduce the frequency and duration of AF. Furthermore, observational studies have shown increased prevalence of AF in patients with OSA and reduced recurrence with CPAP use. However, the effect of CPAP on the burden of AF before and after PVI in patients with OSA has not been examined in a controlled setting.

In this randomized controlled trial, we aimed to assess the effect of treatment with CPAP on the burden and recurrence of AF after PVI in patients with OSA. We used implantable loop recorders (ILRs) to monitor heart rhythm. We also evaluated the effect of CPAP on QoL after PVI.

There were few serious adverse events in our study. Although these events were unlikely to be related to CPAP treatment, such events should be considered in future studies. Our study population consisted of white North-Europeans, mostly men (80%), which may limit the generalizability of our results.

Treatment with CPAP effectively reduced AHI in patients with paroxysmal AF and OSA but did not further reduce the recurrence rate of AF or the time in AF after PVI. PVI is an effective treatment in patients with OSA for reducing AF recurrence and time in AF, as well as QoL symptom scores.​

Effect of continuous positive airway pressure therapy on recurrence of atrial fibrillation after pulmonary vein isolation in patients with obstructive sleep apnea: A randomized controlled trial - ScienceDirect
Heart Rhythm. 2022 Sep;19(9):1433-1441.
Tove-Elizabeth Hunt, Gunn Marit Traaen, Lars Aakerøy, Christina Bendz, Britt Øverland, Harriet Akre, Sigurd Steinshamn, Jan Pål Loennechen, Finn Hegbom, Kaspar Broch, Øyvind H Lie, Erik Lyseggen, Kristina Hermann Haugaa, Lars Gullestad, Ole-Gunnar Anfinsen
PMID: 35716856
DOI: 10.1016/j.hrthm.2022.06.016

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