title: Safety and efficacy of pulmonary vein antral isolation in patients with obstructive sleep apnea: the impact of continuous positive airway pressure.
abstract: 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.
authors.affiliation: St David's Medical Center, Austin, TX, USA.
authors.forename: Dimpi
authors.initials: D
authors.lastname: Patel
authors.forename: Prasant
authors.initials: P
authors.lastname: Mohanty
authors.forename: Luigi
authors.initials: L
authors.lastname: Di Biase
authors.forename: Mazen
authors.initials: M
authors.lastname: Shaheen
authors.forename: William R
authors.initials: WR
authors.lastname: Lewis
authors.forename: Kara
authors.initials: K
authors.lastname: Quan
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Cummings
authors.forename: Paul
authors.initials: P
authors.lastname: Wang
authors.forename: Amin
authors.initials: A
authors.lastname: Al-Ahmad
authors.forename: Preeti
authors.initials: P
authors.lastname: Venkatraman
authors.forename: Eyad
authors.initials: E
authors.lastname: Nashawati
authors.forename: Dhanunjaya
authors.initials: D
authors.lastname: Lakkireddy
authors.forename: Robert
authors.initials: R
authors.lastname: Schweikert
authors.forename: Rodney
authors.initials: R
authors.lastname: Horton
authors.forename: Javier
authors.initials: J
authors.lastname: Sanchez
authors.forename: Joseph
authors.initials: J
authors.lastname: Gallinghouse
authors.forename: Steven
authors.initials: S
authors.lastname: Hao
authors.forename: Salwa
authors.initials: S
authors.lastname: Beheiry
authors.forename: Deb S
authors.initials: DS
authors.lastname: Cardinal
authors.forename: Jason
authors.initials: J
authors.lastname: Zagrodzky
authors.forename: Robert
authors.initials: R
authors.lastname: Canby
authors.forename: Shane
authors.initials: S
authors.lastname: Bailey
authors.forename: J David
authors.initials: JD
authors.lastname: Burkhardt
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
mesh_terms: 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