P907Evaluation of influence of transient apnea and deep breathing recognized only during performing pulmonary vein isolation on maneuver of catheter ablation and recurrence of atrial fibrillation

Abstract

Background: It is known that sleep apnea syndrome(SAS) influences recurrence of atrial fibrillation(AF) after pulmonary vein isolation(PVI). But it is not clear whether drug-induced transient apnea accepted only during performing PVI affects recurrence of AF or not. There is an impression that the deep breathing after apnea makes a maneuver difficult, brings longer operative time, and raises a recurrent rate. Purpose: The aim of this study was to evaluate whether apnea induced by sedative drugs and the deep breathing after apnea affects performance of radio frequency catheter ablation(RFCA) and prognosis. Method: 123 consecutive new patients who were performed PI with radio frequency during the period from August 2011 to December 2014 were studied retrospectively. 79 patients had paroxysmal AF(PAF) and 44 patients had persistent AF(PeAF), and all of them did not have SAS previously. All patients received extensive encircling PV(EEPVI), and received superior vena cava(SVC) isolation if it's necessary. Some of patients with PeAF received ablation of complex fractionated atrial electrogram (CFAE) , mitral isthmus ablation, and/or roof line ablation. All sessions were performed with a 3.5-mm irrigated catheter(Navistar Thermo Cool F/D) and Carto-X-P was used as 3D mapping system. All patients were given pentazocine as a pain-killer, and given propofol and dexmedetomidine as a sedative drug. Thiopental sodium was added if cardioversion was needed. The breathing stop more than 30 seconds was defined as apnea. Results: Mean age was 63.9 years and 90 were men. Mean follow-up duration was 2.8 years. Mean CHA2DS2-VASc score was 2.2 and mean body mass index(BMI) was 23.8. 16 patients revealed apnea during performing catheter ablation, and their BMI was clearly higher than that of patients without apnea(mean BMI: 26.2 vs. 23.5, p=0.001). Moreover, their minimum saturation of arterial blood oxygen(SpO2) was significantly lower than that of patients without apnea(mean SpO2 : 89.0% vs. 95.0%, P<0.001). On the other hand, an operative time was not different between patients with apnea and without apnea(206.8 min vs. 204.8 min, p=0.85). 36 patients had recurrence of AF and/or atrial tachycardia(AT) after 90 days from PVI, and there was not significant difference of probability of recurrence between patients with apnea and without apnea. And patients with apnea did not have any complication, but 1 pericardial tamponade, 2 gastric hypomotility, and 1 acute coronary syndrome were recognized in patients without apnea. 4 patients of all with apnea had a diagnosis of SAS after catheter ablation and then they received appropriate therapy. Conclusion: Drug-induced transient apnea and the deep breathing after apnea did not make an operative time longer, brought less complications, and did not affect probability of recurrence of AF and/or AT. It was thought that an operator performed RFCA more carefully when a patient showed apnea and the deep breathing after apnea.