Radiofrequency Catheter Ablation of Persistent Atrial Fibrillation Decreases a Sleep-Disordered Breathing Parameter During a Short Follow-up Period

Naruse, Yoshihisa; Tada, Hiroshi; Satoh, Makoto; Yanagihara, Mariko; Tsuneoka, Hidekazu; Hirata, Y.; Machino, Takeshi; Yamasaki, Hiro; Igarashi, Miyako; Kuroki, Kenji; Ikoma, Yoko; Sekiguchi, Yukio; Aonuma, Kazutaka

doi:10.1253/circj.cj-12-0014

Cited by 27 publications

(19 citation statements)

References 31 publications

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“…22 Successful restoration of SR resulted in a significant reduction in AHI at 6 months. These findings confirm previous studies which have demonstrated an immediate reduction in AHI 24 hours following DCCV and 1-week post-AF ablation 12,13 and provide insight into the pathophysiology of SDB and link with AF. It is well established that OSA contributes to the development of AF and a number of potential mechanisms have been proposed to explain the association such as intermittent hypoxia, recurrent arousals and increased negative intrathoracic pressure.…”

Section: Discussionsupporting

confidence: 91%

“…Successful restoration of SR resulted in a significant reduction in AHI at 6 months. These findings confirm previous studies which have demonstrated an immediate reduction in AHI 24 hours following DCCV and 1‐week post‐AF ablation and provide insight into the pathophysiology of SDB and link with AF.…”

Section: Discussionsupporting

confidence: 91%

“…11 Recent studies have demonstrated a reduction in nocturnal respiratory events (apnoeas and hypopnoeas) with successful direct current cardioversion (DCCV) and AF ablation procedures at short-term follow-up. 12,13 The long-term effects of randomized AF intervention on sleep data were evaluated at baseline and at 6 months utilizing the Watch-PAT200 (WP) (Itamar Medical Lts., Caesarea, Israel). This device has been shown to have high correlation with the gold standard assessment of SDB, overnight polysomnography (PSG).…”

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confidence: 99%

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The effect of atrial fibrillation intervention on nocturnal respiratory events in elderly patients with persistent AF

Eysenck

Sulke

Freemantle

et al. 2019

Clinical Respiratory J

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Background Sleep‐disordered breathing (SDB) and atrial fibrillation (AF) are associated. This study investigated the impact of AF intervention on 6‐month home sleep testing data. Methods Sixty‐seven patients (aged 66 to 86, 53% male) with persistent AF were randomized (1:1:1) to direct current cardioversion (DCCV) (22 patients), permanent pacemaker (PPM) + atrioventricular node ablation (AVNA) + DCCV (22 patients) or AF ablation (23 patients). Baseline and 6‐month multichannel home sleep tests with the Watch‐PAT200 (Itamar Medical Lts., Caesarea, Israel) were recorded. Implantable cardiac monitors (ICMs) (Medtronic Reveal XT, Minneapolis, Minnesota) in the DCCV and AF ablation groups, and PPM Holters in the ‘pace and ablate’ group were utilized to assess cardiac rhythm beat‐to‐beat throughout the study period. Results The prevalence of moderate‐to‐severe SDB [apnoea‐hypopnoea index (AHI) ≥ 15/h] was 60%. At 6 months there was no change in AHI, Epworth sleepiness scale, sleep time, % REM sleep, respiratory desaturation index or central apnoeic events. Twenty‐five patients (15 AF ablation, 9 DCCV and 1 following DCCV post‐AVNA) maintained SR at 6 months confirmed on ICMs in these patients. AHI fell from 29.8 ± 26.6/h to 22.2 ± 20.4/h; P = 0.049. Conclusions SDB is highly prevalent in patients with persistent AF. Restoration of sinus rhythm, and the associated long‐term recovery of haemodynamics, is associated with a significant reduction in AHI. This implicates reversal of fluid shift from the lower limbs to the neck region, a key mechanism in the pathogenesis of SDB.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 91%

mentioning

confidence: 99%

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The effect of atrial fibrillation intervention on nocturnal respiratory events in elderly patients with persistent AF

Eysenck

Sulke

Freemantle

et al. 2019

Clinical Respiratory J

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“…The Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) registry found that participants with sleep apnoea were more likely to have more severe or disabling symptoms as compared with participants without OSA (22% vs 16%), and more likely to be receiving rhythm control therapy (35% vs 31%, respectively) 47. In a reverse association, studies have found favourable effect of treatment of AF on central sleep apnoea,48 and a significant reduction in AHI in patients with SDB 49…”

Section: Sleep Apnoea As Vascular Risk Factormentioning

confidence: 99%

Sleep apnoea and stroke

Sharma

Culebras

2016

Stroke Vasc Neurol

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Sleep disorders have been known to physicians for a long time. In his famous aphorisms, Hippocrates said “Sleep or watchfulness exceeding that which is customary, augurs unfavorably”. Modern medicine has been able to disentangle some of the phenomena that disturb sleep. Among the most notable offenders is sleep apnoea that has gained prominence in the past few decades. It is being proposed as one of the potentially modifiable risk factors for vascular diseases including stroke. The pathological mechanisms linking sleep apnoea to vascular risk factors include hypoxia, cardiac arrhythmias, dysautonomia, impaired glucose tolerance, hypertension, dyslipidaemia and inflammation. In this article, we review literature linking sleep apnoea and stroke, including sleep apnoea as a risk factor for primary prevention with the potential to improve outcome after acute stroke and as a secondary risk factor, amenable to modification and hence vascular risk reduction.

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“…Naruse et al. reported a decrease in the obstructive apnea-hypopnea index among 25 patients after radiofrequency catheter ablation of atrial fibrillation (32). They, however, only investigated patients with sleep apnea at baseline and not the whole cohort, which introduces a risk for regression towards the mean because of selection bias.…”

Section: Discussionmentioning

confidence: 99%

Cardioversion of atrial fibrillation does not affect obstructive sleep apnea

Höglund

Sahlin

Kesek

et al. 2017

Upsala Journal of Medical Sciences

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BackgroundSleep apnea is common in patients with atrial fibrillation, but the effect of the cardioversion of atrial fibrillation to sinus rhythm on central and obstructive apneas is mainly unknown. The primary aim of the study was to analyze the association between cardioversion of atrial fibrillation and sleep apneas, to investigate whether obstructive or central sleep apneas are reduced following cardioversion. A secondary objective was to study the effect on sleep quality.MethodsTwenty-three patients with atrial fibrillation were investigated using overnight polysomnography, including esophagus pressure monitoring and ECG, before and after the cardioversion of persistent atrial fibrillation.ResultsObstructive sleep apnea occurred in 17/23 patients (74%), and central sleep apnea in 6/23 patients (26%). Five patients had both obstructive and central sleep apnea. Sinus rhythm at follow-up was achieved in 16 patients. The obstructive apnea-hypopnea index, central apnea-hypopnea index, and the number of patients with obstructive or central sleep apnea did not differ before and after restoration of sinus rhythm. Sleep time, sleep efficiency, time in different sleep stages, and subjective daytime sleepiness were normal and unaffected by cardioversion.ConclusionsBoth obstructive and central sleep apneas are highly prevalent in patients with persistent atrial fibrillation. Obstructive sleep apneas are unaffected by the cardioversion of atrial fibrillation to sinus rhythm. The sleep pattern is normal and unaffected by cardioversion in patients with atrial fibrillation.Clinical Trial RegistrationTrial number NCT00429884.

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Radiofrequency Catheter Ablation of Persistent Atrial Fibrillation Decreases a Sleep-Disordered Breathing Parameter During a Short Follow-up Period

Cited by 27 publications

References 31 publications

The effect of atrial fibrillation intervention on nocturnal respiratory events in elderly patients with persistent AF

The effect of atrial fibrillation intervention on nocturnal respiratory events in elderly patients with persistent AF

Sleep apnoea and stroke

Cardioversion of atrial fibrillation does not affect obstructive sleep apnea

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