The impact of sleep apnea on right atrial structural remodeling with atrial fibrillation

Abstract

Background: Atrial remodeling associated with atrial fibrillation (AF) and sleep apnea is well known. Although sleep apnea is known to be associated with left atrial (LA) remodeling, its association with right atrial (RA) remodeling remains unclear. The study aimed to investigate the effect of sleep apnea on RA remodeling. Methods: We enrolled 141 AF patients who had undergone ablation. Sleep study results were evaluated using a portable sleep apnea test device. RA and LA volumes were determined by computed tomography (CT), and atrial structural remodeling was defined as atrial volume on CT ! 110 mL according to previous reports. The atrial substrate was evaluated by three-dimensional electroanatomical mapping. Results: After excluding 30 patients who received more than one catheter ablation or who could not receive enhanced CT, 111 patients were finally analyzed. The patients were classified into four groups according to the presence of RA and/or LA enlargement. Significant differences in AF type, N-terminal pro B-type natriuretic peptide (NT-proBNP) levels, and apnea-hypopnea index (AHI) were observed among the four groups. In univariate analysis, AHI values correlated with NT-proBNP levels (r = 0.293, p = 0.002), left ventricular ejection fraction (r = À0.198, p = 0.044), LA volume (r = 0.370, p < 0.001), and RA volume (r = 0.465, p < 0.001). Multiple regression analysis showed that AHI was an independent predictor of increased RA volume, and LA was excluded as a multiple risk factor in AHI. AF type-adjusted AHI levels correlated with RA volume, and RA remodeling correlated with the percentage of LA low-voltage area. Conclusions: Sleep apnea was strongly associated with RA structural remodeling regardless of paroxysmal and non-paroxysmal AF, and this relationship was more prominent than the effect of LA. Our results suggest that the association between sleep apnea and RA dilatation should be given attention.

Impact of right atrial structural remodeling on recurrence after ablation for atrial fibrillation

“…In addition, the impact of sleep apnea on recurrence may be considered in only the RA remodeling group without LA remodeling. We previously reported a correlation between RA structural remodeling and sleep apnea and showed that RA structural remodeling correlated with the severity of sleep apnea regardless of the AF type 16 . Importantly, previous studies have found that sleep apnea was a predictor of failure of rhythm control strategies, such as AF ablation 31 .…”

“…In the RA volume measurements, the inferior and superior vena cava at their ostia were manually excluded. In this study, we defined an atrial volume on CT of ≥110 mL as atrial structural remodeling based on receiver operating characteristic (ROC) analysis and previous reports 12‐16 …”

“…To compare the strength of the parameters to predict arrhythmia recurrence, the area under the ROC curve for each parameter was estimated. The Kaplan–Meier analysis and log‐rank test were used to compare arrhythmia‐free survival rates between the two groups, which were divided based on the optimal cutoff value according to our previous report 16 and the results of ROC analysis. A multivariate analysis using stepwise regression with backward elimination was performed to identify independent risk factors associated with RA volume.…”

The Association of Cardio-Ankle Vascular Index (CAVI) with Biatrial Remodeling in Atrial Fibrillation

“…In our study, 118 participants (55.4%) had abnormal CAVI values (≥ 9). The patients with abnormal CAVI values were older and had higher CHADS2 scores, CHA2DS2VASc scores, mapping were performed in order to investigate the relationship between structural and electrical remodeling during SR, as previously described 18,19) . Voltage and activation timing was recorded in a bipolar contact map using the high-density circular mapping catheter.…”

Deep Learning-Based Recurrence Prediction of Atrial Fibrillation After Catheter Ablation

“…A non-contact ablation protocol has been previously published. 16 Contact guide ablation using a TactiCath CF sensing catheter targeted to 10-40 g, catheter stability and CF waveforms were monitored visually, and the lesion size was target to the standard value (from 5 to 6 points). Esophageal temperature monitoring was performed in all patients.…”