title: Obstructive sleep apnea in patients with typical atrial flutter: prevalence and impact on arrhythmia control outcome.
abstract: BACKGROUND
  The clinical yield of cavotricuspid isthmus (CTI) radiofrequency ablation of atrial flutter (AF) is limited by a high incidence of atrial fibrillation (AFib) in the long term. Among other acknowledged variables, the association of obstructive sleep apnea (OSA) could favor incomplete arrhythmia control in this setting. We assessed the impact of CPAP in reducing the occurrence of AFib after CTI ablation.
  
  
  METHODS
  Consecutive patients with AF who were undergoing CTI ablation were screened for OSA. Relationship of the following variables with the occurrence of AFib during follow-up (12 months) was investigated: CPAP initiation, hypertension, BMI, underlying structural heart disease, left atrial diameter, and AFib documentation prior to ablation.
  
  
  RESULTS
  We prospectively included 56 patients (mean age: 66 (± 11) years; 12 female patients), of whom 46 (82%) had OSA and 25 (45%) had severe OSA. Twenty-one patients (38%) had AFib during follow-up after CTI ablation. Both freedom from AFib prior to ablation and CPAP initiation in those patients without previously documented AFib at inclusion were associated with a reduction of AFib episodes during follow-up (P = .019 and P = .025, respectively). Inversely, CPAP was not protective from AFib recurrence when this arrhythmia was documented prior to ablation (P = .25).
  
  
  CONCLUSIONS
  OSA is a prevalent condition in patients with AF. Treatment with CPAP is associated with a lower incidence of newly diagnosed AFib after CTI ablation. Screening for OSA in patients with AF appears to be a reasonable clinical strategy.
authors.affiliation: Electrophysiology Unit, Cardiology Department, Barcelona, Spain. Electronic address: vbazan@hospitaldelmar.cat.
authors.forename: Victor
authors.initials: V
authors.lastname: Bazan
authors.affiliation: Sleep Disorders Unit, Respiratory Medicine Department, Hospital del Mar, Parc de Salut Mar, UAB-UPF, CIBERES, ISC III, Barcelona, Spain.
authors.forename: Nuria
authors.initials: N
authors.lastname: Grau
authors.affiliation: Electrophysiology Unit, Cardiology Department, Barcelona, Spain.
authors.forename: Ermengol
authors.initials: E
authors.lastname: Valles
authors.affiliation: Sleep Disorders Unit, Respiratory Medicine Department, Hospital del Mar, Parc de Salut Mar, UAB-UPF, CIBERES, ISC III, Barcelona, Spain.
authors.forename: Miquel
authors.initials: M
authors.lastname: Felez
authors.affiliation: Sleep Disorders Unit, Respiratory Medicine Department, Hospital del Mar, Parc de Salut Mar, UAB-UPF, CIBERES, ISC III, Barcelona, Spain.
authors.forename: Carles
authors.initials: C
authors.lastname: Sanjuas
authors.affiliation: Electrophysiology Unit, Cardiology Department, Barcelona, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Cainzos-Achirica
authors.affiliation: Electrophysiology Unit, Cardiology Department, Barcelona, Spain.
authors.forename: Begoña
authors.initials: B
authors.lastname: Benito
authors.affiliation: Electrophysiology Unit, Cardiology Department, Barcelona, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Jauregui-Abularach
authors.affiliation: Sleep Disorders Unit, Respiratory Medicine Department, Hospital del Mar, Parc de Salut Mar, UAB-UPF, CIBERES, ISC III, Barcelona, Spain.
authors.forename: Joaquim
authors.initials: J
authors.lastname: Gea
authors.affiliation: Electrophysiology Unit, Cardiology Department, Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Bruguera-Cortada
authors.affiliation: Electrophysiology Unit, Cardiology Department, Barcelona, Spain.
authors.forename: Julio
authors.initials: J
authors.lastname: Marti-Almor
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy*; D001282:Atrial Flutter / Q000503:physiopathology / Q000601:surgery*; D015992:Body Mass Index; D017115:Catheter Ablation; D045422:Continuous Positive Airway Pressure; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000503:physiopathology; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D011446:Prospective Studies; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology* / Q000503:physiopathology; D016896:Treatment Outcome