title: Treatment of obstructive sleep apnea reduces the risk of atrial fibrillation recurrence after catheter ablation.
abstract: OBJECTIVE
  The aim of this study was to examine the effect of continuous positive airway pressure (CPAP) therapy on atrial fibrillation (AF) recurrence in patients with obstructive sleep apnea (OSA) undergoing pulmonary vein isolation (PVI).
  
  
  BACKGROUND
  OSA is a predictor of AF recurrence following PVI. However, the impact of CPAP therapy on PVI outcome in patients with OSA is poorly known.
  
  
  METHODS
  Among 426 patients who underwent PVI between 2007 and 2010, 62 patients had a polysomnography-confirmed diagnosis of OSA. While 32 patients were "CPAP users" the remaining 30 patients were "CPAP nonusers." The recurrence of any atrial tachyarrhythmia, use of antiarrhythmic drugs, and need for repeat ablations were compared between the groups during a follow-up period of 12 months. Additionally, the outcome of patients with OSA was compared to a group of patients from the same PVI cohort without OSA.
  
  
  RESULTS
  CPAP therapy resulted in higher AF-free survival rate (71.9% vs. 36.7%; p = 0.01) and AF-free survival off antiarrhythmic drugs or repeat ablation following PVI (65.6% vs. 33.3%; p = 0.02). AF recurrence rate of CPAP-treated patients was similar to a group of patients without OSA (HR: 0.7, p = 0.46). AF recurrence following PVI in CPAP nonuser patients was significantly higher (HR: 2.4, p < 0.02) and similar to that of OSA patients managed medically without ablation (HR: 2.1, p = 0.68).
  
  
  CONCLUSIONS
  CPAP is an important therapy in OSA patients undergoing PVI that improves arrhythmia free survival. PVI offers limited value to OSA patients not treated with CPAP.
authors.affiliation: Harvard Thorndike Electrophysiology Institute, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors.forename: Adam S
authors.initials: AS
authors.lastname: Fein
authors.forename: Alexei
authors.initials: A
authors.lastname: Shvilkin
authors.forename: Dhaval
authors.initials: D
authors.lastname: Shah
authors.forename: Charles I
authors.initials: CI
authors.lastname: Haffajee
authors.forename: Saumya
authors.initials: S
authors.lastname: Das
authors.forename: Kapil
authors.initials: K
authors.lastname: Kumar
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Kramer
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Zimetbaum
authors.forename: Alfred E
authors.initials: AE
authors.lastname: Buxton
authors.forename: Mark E
authors.initials: ME
authors.lastname: Josephson
authors.forename: Elad
authors.initials: E
authors.lastname: Anter
mesh_terms: D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000503:physiopathology / Q000517:prevention & control*; D017115:Catheter Ablation / Q000009:adverse effects*; D045422:Continuous Positive Airway Pressure / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography / Q000379:methods; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents
keywords: AAD; AF; BMI; CPAP; LAD; OSA; PVI; ablation; antiarrhythmic drug; atrial fibrillation; body mass index; continuous positive airway pressure; left atrial dimension; obstructive sleep apnea; pulmonary vein isolation