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

Hunt, Tove-Elizabeth; Traaen, Gunn Marit; Aakerøy, Lars; Bendz, Christina; Øverland, Britt; Akre, Harriet; Steinshamn, Sigurd; Loennechen, Jan Pål; Hegbom, Finn; Broch, Kaspar; Lie, Øyvind; Lyseggen, Erik; Haugaa, Kristina H; Gullestad, Lars; Anfinsen, Ole-Gunnar

doi:10.1016/j.hrthm.2022.06.016

Cited by 33 publications

(42 citation statements)

References 16 publications

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“…Recently, a randomized controlled trial showed that CPAP treatment did not reduce AF recurrence after catheter ablation in patients with paroxysmal AF. The AF recurrence‐free rate between the OSA‐CPAP and OSA standard care groups was 43%, as confirmed using an implantable loop recorder 54 . It has been reported that sinus rhythm maintenance after pulmonary vein isolation was 65.7–87% according to data from a loop recorder implanted in patients with paroxysmal AF 55,56 .…”

Section: Management Of Sleep Apnea (Catheter Ablation Of Af and Osa)mentioning

confidence: 63%

“…The AF recurrence‐free rate between the OSA‐CPAP and OSA standard care groups was 43%, as confirmed using an implantable loop recorder. 54 It has been reported that sinus rhythm maintenance after pulmonary vein isolation was 65.7–87% according to data from a loop recorder implanted in patients with paroxysmal AF. 55 , 56 The patient population may include a more advanced arrhythmogenic substrate of AF, even in the paroxysmal type.…”

Section: Management Of Sleep Apnea (Catheter Ablation Of Af...mentioning

confidence: 99%

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Mechanism and management of atrial fibrillation in the patients with obstructive sleep apnea

Iwasaki

2022

Journal of Arrhythmia

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Obstructive sleep apnea (OSA) is a highly prevalent disorder in patients with atrial fibrillation (AF). Although there has been an increase in the incidence of AF due to the aging population, it has been reported that OSA is still underdiagnosed because many patients remain asymptomatic or unaware of the symptoms associated with OSA, such as daytime sleepiness. Untreated OSA reduces the effectiveness of AF treatment, regardless of pharmacological or non‐pharmacological modes of therapy, such as catheter ablation. Experimental and clinical studies have shown that OSA pathophysiology is multifactorial, comprising of hypoxemia, hypercapnia, autonomic dysfunction, negative intrathoracic pressure changes, and arousals of OSA, and lead to AF. Both the acute and long‐term effects of obstructive apnea episodes are involved in the development of an arrhythmogenic substrate of AF. Undiagnosed OSA causes underutilized opportunities for more effective AF management. Therefore, it is important to screen for OSA in all patients being considered for rhythm control therapy. However, regardless of the growing evidence of the negative prognostic impact of OSA, there is a lack of awareness regarding this connection not only among patients but also among cardiologists and arrhythmia specialists. There is a barrier to performing a systemic screening for OSA in clinical practice. Therefore, it is important to establish a comprehensive OSA care team for the efficient diagnosis and treatment of OSA. This review provides the current understanding of OSA and its relationship to AF and the importance of the diagnosis and management of OSA in AF.

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Section: Management Of Sleep Apnea (Catheter Ablation Of Af and Osa)mentioning

confidence: 63%

Section: Management Of Sleep Apnea (Catheter Ablation Of Af...mentioning

confidence: 99%

Mechanism and management of atrial fibrillation in the patients with obstructive sleep apnea

Iwasaki

2022

Journal of Arrhythmia

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“…Five studies were not in the nal analysis because of the lacking of any sleep study to assess OSA. Finally, eight articles were included in our study for meta-analysis [13,[20][21][22][23][24][25][26]. Each article was evaluated thoroughly, and the quality of all the articles met the inclusion criteria.…”

Section: Search Resultsmentioning

confidence: 99%

“…The main characteristics of the eight studies and the 1372 patients are listed in Tables 2 and 3. Totally, there were 6 observational studies [20][21][22][23]25,26] and 2 RCTs [13,24]. The duration of the follow-up ranged from 12 to 32 months.…”

Section: Study Characteristicsmentioning

confidence: 99%

Continuous positive airway pressure therapy prevents the recurrence of atrial fibrillation in patients with severer atrial fibrillation and hypertension: a systematic review and meta-analysis

Wang

Luo

Huang

et al. 2022

Preprint

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Background: A higher incidence of atrial fibrillation is linked to obstructive sleep apnea. The effects of continuous positive airway pressure on atrial fibrillation have been studied in observational studies and randomized controlled trials. We conducted this meta-analysis to assess the effect of continuous positive airway pressure therapy on the recurrence of atrial fibrillation after conversion to sinus rhythm in obstructive sleep apnea patients. Methods: A comprehensive search was conducted in MEDLINE, Embase, Cochrane, and Web of Science databases from inception till October 2022. We included cohort studies and randomized controlled trials containing the recurrent situation of atrial fibrillation after catheter ablation or direct current cardioversion with and without continuous positive airway pressure therapy. The random-effects model was used to evaluate the odds ratios (OR) and confidence intervals (CI). I2 was used to assess the heterogeneity. Results: 8 studies with a total of 1372 obstructive sleep apnea patients met the inclusion criteria. Continuous positive airway pressure therapy decreased atrial fibrillation recurrence by 57% (OR=0.43, 95% CI 0.29-0.64, I2=38.0%). Subgroup analysis showed that the protective effect was more significant in groups with a higher burden of atrial fibrillation (OR 0.294 vs. 0.622, 95% CI 0.164-0.524 vs. 0.376-1.027, p=0.055) and with more hypertension patients (OR 0.272 vs. 0.550, 95% CI 0.165-0.449 vs. 0.329-0.922, p=0.054). Age, body mass index, severity of OSA, and therapy compliance had no significant effect on the recurrence of atrial fibrillation. Conclusions: Continuous positive airway pressure therapy decreased the atrial fibrillation recurrence rate. The severity of atrial fibrillation and hypertension both had an impact on it. Studies focused on the effects of the severity of OSA and treatment compliance, and more randomized controlled trials are needed in the future.

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“…118 Likewise, in a randomised trial of 37 patients receiving continuous positive airway pressure and 46 patients receiving standard care, no difference was reported in AF burden after pulmonary vein isolation between groups. 119 Discrepancies between observational and randomised data might be due to selection of individuals with minimal symptoms in clinical trials. Patients with symptoms are more likely to be established on CPAP and physicians might be reluctant to recruit them to studies where the patients are randomly assigned to a control arm.…”

Section: Continuous Positive Airway Pressurementioning

confidence: 99%

Obesity as a risk factor for cardiac arrhythmias

Patel

Reddy

et al. 2022

bmjmed

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Obesity is global health problem with an estimated three billion people worldwide being classified as overweight or obese. In addition to being associated with a range of adverse health outcomes, obesity is linked to higher risks of atrial and ventricular arrhythmias, as well as sudden cardiac death. Obesity is a multifactorial disease that often co-exists with hypertension, diabetes, and sleep apnoea, which are also independent risk factors for cardiac arrhythmias. Nevertheless, compelling evidence suggests that increasing adiposity is an independent proarrhythmic risk factor and that weight loss can be a mitigating and preventative intervention to reduce arrhythmia incidence. This review briefly outlines the economic and social burden of obesity and summarises evidence for the direct and indirect effects of increasing adiposity on risk of atrial and ventricular arrhythmias. The paper also summarises the evidence for electrocardiographic changes indicative of obesity-related atrial and ventricular remodelling and how weight reduction and management of comorbidity might reduce arrhythmic burden.

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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

Cited by 33 publications

References 16 publications

Mechanism and management of atrial fibrillation in the patients with obstructive sleep apnea

Mechanism and management of atrial fibrillation in the patients with obstructive sleep apnea

Continuous positive airway pressure therapy prevents the recurrence of atrial fibrillation in patients with severer atrial fibrillation and hypertension: a systematic review and meta-analysis

Obesity as a risk factor for cardiac arrhythmias

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