Atrial fibrillation, sleep apnea and obesity.
BACKGROUND
A 60-year-old male with obesity (body-mass index 43 kg/m(2)) presented with recurrent symptomatic atrial fibrillation (AF), which he had had since age 41 years. The AF was refractory to treatment with antiarrhythmic drugs. Pacemaker implantation for tachycardia-bradycardia syndrome was required as well as ablation for atrial flutter, and the patient underwent a total of four DC cardioversions. Sleep studies showed mild to moderate obstructive sleep apnea, but continuous positive airway pressure was not tolerated. Pacemaker interrogations demonstrated mode-switch episodes, indicating continuing AF. He was scheduled for catheter ablation targeting pulmonary vein antral isolation. He embarked on a weight-loss program, which successfully reduced AF burden.


METHODS
Echocardiography, stress testing, polysomnography, pacemaker interrogations and C-reactive protein.


METHODS
AF, atrial flutter, tachycardia-bradycardia syndrome, obstructive sleep apnea and morbid obesity.


RESULTS
Antiarrhythmic drug therapy, DC cardioversion, anticoagulation, atrial flutter ablation, permanent pacemaker implantation, continuous positive airway pressure and weight loss.
Chung
Mina K
MK
Department of Cardiovascular Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk F-15, Cleveland, OH 44195, USA. chungm@ccf.org
Foldvary-Schaefer
Nancy
N
Somers
Virend K
VK
Friedman
Paul A
PA
Wang
Paul J
PJ
D001281:Atrial Fibrillation / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D015992:Body Mass Index; D002304:Cardiac Pacing, Artificial; D017115:Catheter Ablation / Q000379:methods; D004554:Electric Countershock; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000628:therapy; D017286:Polysomnography; D011667:Pulmonary Veins / Q000601:surgery; D012891:Sleep Apnea Syndromes / Q000150:complications* / Q000503:physiopathology; D015431:Weight Loss