1233 Recurrent Atrial Fibrillation Responsive to CPAP

Abstract

Introduction: The association between atrial fibrillation (AF) and obstructive sleep apnea (OSA) is well established. We present a case of recurrent nighttime AF responsive to CPAP therapy in a patient previously treated with catheter ablation. Report of Case: A 67 year old man, with a prior history of catheter ablation of AF, presented with complaints of episodic, nighttime palpitations and excessive daytime sleepiness. Initial catheter ablation four years prior resulted in resolution of his palpitations. Approximately a year after the ablation his palpitations returned. These events would only occur at night and awaken him from sleep. Holter monitoring showed baseline sinus rhythm with multiple episodes of nocturnal AF with rates of 75 to 169 beats/min correlating with his nocturnal palpitations. The patient's wife reported that he snored loudly and had occasional apneic episodes. He was referred for a monitored sleep study. The apnea hypopnea index (AHI) was 36/hr overall with nadir desaturation to 72%. There were occasional short runs of atrial fibrillation on the night of the polysomnography correlating with decreased air flow. CPAP at 10 cm H20 treated the sleep disordered breathing and normalized the oxygen saturation. Initially the patient was non-compliant with CPAP but upon further education and encouragement he improved compliance. The patient reported resolution of the nocturnal palpitations after adherence with CPAP. A follow-up holter monitor did not reveal further AF. Conclusion: Patients with OSA have a four-fold risk of developing AF compared to patients without sleep disordered breathing and may develop AF that recurs after catheter ablation. Patients with AF, especially if recurring after ablation should be screened for OSA. Treatment of OSA may help reduce the risk of developing incident AF.