Abstract 9968: Radiofrequency Catheter Ablation for Persistent Atrial Fibrillation Improves Sleep-Disordered Breathing

Abstract

Background: Recent studies have suggested an emerging link between sleep apnea and atrial fibrillation (AF). Radiofrequency catheter ablation is becoming an effective therapeutic option for drug-refractory AF. However, the effect of radiofrequency catheter ablation on sleep-disordered breathing has not been sufficiently clarified. Methods: This study included 19 patients (18 men and 1 woman; 62±6 years) with sleep apnea syndrome who underwent radiofrequency catheter ablation for drug refractory, persistent AF. The standard overnight polysomnographic evaluation was performed before and 1 week after the ablation in all patients. The total duration and number of episodes of central or obstructive sleep apnea or hypopnea were analyzed and compared. Results: Among 19 patients, all patients predominantly had obstructive apnea (obstructive apnea index, median 13.8, IQR (interquartile range) 7.1-20.9; central apnea index, 0.2, IQR 0.0-0.5; p<0.001). One week after the ablation, the number of apnea hypopnea index (21, [IQR 12-39] to 10, [IQR 6-24]; p=0.001) and obstructive type of apnea (14, [IQR 7-21] to 7, [IQR 2-16]; p=0.002) were significantly reduced. Median % change of apnea hypopnea index was 42% (IQR 22-60). In 9 (47%) patients, the severity of sleep-disorder breathing improved after the ablation. Furthermore, the sleep-disorder breathing was normalized after the ablation in 2 (11%) patients. In 3 patients who did not maintain sinus rhythm after the ablation, the apnea hypopnea index did not improve, and there was a significant correlation between rhythm control after radiofrequency catheter ablation and % change of apnea hypopnea index (rs=0.63, p=0.004). Body weight (70.8±11.3 to 69.6±10.9 [kg], p<0.001), plasma N-terminal pro B-type natriuretic peptide level (384, [IQR 237-610] to 106 [66-166] [pg/ml], p=0.001), left atrial volume (65±22 to 56±17 [ml], p=0.048), and estimate pulmonary capillary wedge pressure (13±4 to 11±3 [mmHg], p=0.006) were also reduced significantly after the ablation. Conclusions: In patients with sleep apnea syndrome and persistent AF, to restore sinus rhythm by radiofrequency catheter ablation significantly improves obstructive sleep apnea.