Concomitant obstructive sleep apnea increases the recurrence of atrial fibrillation following radiofrequency catheter ablation of atrial fibrillation: clinical impact of continuous positive airway pressure therapy

Heart Rhythm. 2013 Mar;10(3):331-7. doi: 10.1016/j.hrthm.2012.11.015. Epub 2012 Nov 23.


Background: Recent studies have suggested an emerging link between obstructive sleep apnea (OSA) and atrial fibrillation (AF). Patients with OSA are less likely to remain in sinus rhythm after radiofrequency catheter ablation of AF.

Objective: To evaluate the efficacy of appropriate treatment with continuous positive airway pressure (CPAP) on recurrences of AF after ablation.

Methods: This study prospectively included 153 patients (128 men; 60 ± 9 years) who underwent extensive encircling pulmonary vein isolation for drug refractory AF. The standard overnight polysomnographic evaluation was performed 1 week after ablation, and the total duration and the number of central or obstructive sleep apnea or hypopnea episodes were examined.

Results: Of 153 patients, 116 patients were identified as having OSA. Data regarding the use of CPAP and recurrences of AF were obtained in 82 patients. The remaining 34 patients with OSA were defined as the no-CPAP group. Polysomnography revealed no sleep-disordered breathing in 37 patients. During a mean follow-up period of 18.8 ± 10.3 months, 51 (33%) patients experienced AF recurrences after ablation. A Cox regression analysis revealed that the left atrial volume (hazard ratio [HR] 1.11; 95% confidence interval [CI] 1.01-1.23; P<.05), concomitant OSA (HR 2.61; 95% CI 1.12-6.09; P<.05), and usage of CPAP therapy (HR 0.41; 95% CI 0.22-0.76; P<.01) were associated with AF recurrences during the follow-up period.

Conclusions: Patients with untreated OSA have a higher recurrence of AF after ablation. Appropriate treatment with CPAP in patients with OSA is associated with a lower recurrence of AF.

Publication types

  • Comparative Study

MeSH terms

  • Atrial Fibrillation / complications*
  • Atrial Fibrillation / epidemiology
  • Atrial Fibrillation / surgery
  • Catheter Ablation*
  • Continuous Positive Airway Pressure / methods*
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Polysomnography
  • Prognosis
  • Prospective Studies
  • Recurrence
  • Sleep Apnea, Obstructive / complications*
  • Sleep Apnea, Obstructive / physiopathology
  • Sleep Apnea, Obstructive / therapy