Effect of continuous positive airway pressure therapy on recurrence of atrial fibrillation after catheter ablation in patients with obstructive sleep apnea: A randomized controlled trial

Abstract

Background: Obstructive sleep apnea (OSA) is common in patients with atrial fibrillation (AF). Studies have reported an association between OSA and increased AF burden, as well as increased recurrence of AF after catheter ablation. However, whether treatment with positive airway pressure (CPAP) can reduce the risk of AF recurrence after pulmonary vein isolation has still not been established. Purpose: This is the first randomized study evaluating the effect of CPAP treatment on AF recurrence after pulmonary vein isolation in patients with AF and OSA. Methods: Consecutive patients with AF referred for catheter ablation were included after being screened positive for OSA (apnea‐hypopnea index [AHI] ≥ 15 events/h). All patients received an implantable loop recorder 6 months prior to ablation to quantify the arrhythmia burden. Patients were randomized to CPAP treatment or no treatment of OSA during five months before and 12 months after ablation. The primary end point was AF recurrence, defined as one episode of AF lasting longer than 30 seconds after catheter ablation, with an initial 90‐day blanking period. We also compared AF burden measured in percent of time in AF and assessed five months before and 3‐12 months after catheter ablation. Results: We included 83 patients (65% male, age 61 ± 7.3 years), of which 37 patients were treated with CPAP and 46 controls. The mean baseline AHI in patients with CPAP was 26.7 ± 14.7 and in patients with usual care 26.3 ± 12.3. AF‐burden prior to catheter ablation expressed as median [IQR] percent of time was 2.7 [0.9‐9.1] in the CPAP‐group compared to 1.8 [0.2‐6.4] in the control group (p = 0.24). There was no signal to a difference in AF recurrence rate between patients with or without CPAP treatment. As shown in figure, we found overlapping curves with a final 21 patients [57%] vs. 26 patients (57%) presenting at least 30 seconds of AF. After catheter ablation and blanking period, patients with CPAP treatment had an AF burden of 0.0 [0.0‐0.3] % compared to 0.0 [0.0‐0.3] % in patients without CPAP (p = 0.64). Conclusion: In this randomized study concomitant treatment with CPAP on top of pulmonary vein isolation had no added effect on the risk of AF recurrence in patients with OSA. Although several patients revealed at least 30 seconds of AF 3‐12 months after ablation, there was a great reduction in percent AF burden after catheter ablation independent of CPAP treatment. (Figure Presnted).