Safety and efficacy of pulmonary vein antral isolation in patients with obstructive sleep apnea: the impact of continuous positive airway pressure.
BACKGROUND
Obstructive sleep apnea (OSA) may be associated with pulmonary vein antrum isolation (PVAI) failure. The aim of the present study was to investigate if treatment with continuous positive airway pressure (CPAP) improved PVAI success rates.


RESULTS
From January 2004 to December 2007, 3000 consecutive patients underwent PVAI. Patients were screened for OSA and CPAP use. Six hundred forty (21.3%) patients had OSA. Patients with OSA had more procedural failures (P=0.024) and hematomas (P<0.001). Eight percent of the non-OSA paroxysmal atrial fibrillation patients had nonpulmonary vein antrum triggers (non-PV triggers) and posterior wall firing versus 20% of the OSA group (P<0.001). Nineteen percent of the non-OSA nonparoxysmal atrial fibrillation population had non-PV triggers versus 31% in the OSA group (P=0.001). At the end of the follow-up period (32±14 months), 79% of the non-CPAP and 68% of the CPAP group were free of atrial fibrillation (P=0.003). Not using CPAP in addition to having non-PV triggers strongly predicted procedural failure (hazard ratio, 8.81; P<0.001).


CONCLUSIONS
OSA was an independent predictor for PVAI failure. Treatment with CPAP improved PVAI success rates. Patients not treated with CPAP in addition to having higher prevalence of non-PV triggers were 8 times more likely to fail the procedure.
Patel
Dimpi
D
St David's Medical Center, Austin, TX, USA.
Mohanty
Prasant
P
Di Biase
Luigi
L
Shaheen
Mazen
M
Lewis
William R
WR
Quan
Kara
K
Cummings
Jennifer E
JE
Wang
Paul
P
Al-Ahmad
Amin
A
Venkatraman
Preeti
P
Nashawati
Eyad
E
Lakkireddy
Dhanunjaya
D
Schweikert
Robert
R
Horton
Rodney
R
Sanchez
Javier
J
Gallinghouse
Joseph
J
Hao
Steven
S
Beheiry
Salwa
S
Cardinal
Deb S
DS
Zagrodzky
Jason
J
Canby
Robert
R
Bailey
Shane
S
Burkhardt
J David
JD
Natale
Andrea
A
D001281:Atrial Fibrillation / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D045422:Continuous Positive Airway Pressure / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery*; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery*; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome