title: Pacemaker-detected severe sleep apnea predicts new-onset atrial fibrillation.
abstract: OBJECTIVE
  Sleep apnea (SA) diagnosed on overnight polysomnography is a risk factor for atrial fibrillation (AF). Advanced pacemakers are now able to monitor intrathoracic impedance for automatic detection of SA events.
  
  
  RESULTS
  We enrolled 160 consecutive recipients of a dual-chamber pacemaker endowed with the ApneaScan algorithm (Boston Scientific). If the pacemaker-measured Respiratory Disturbance Index was ≥30 episodes per hour for at least one night during the first week after implantation, SA was defined as severe. Patients were considered to have experienced AF episodes if the device detected a cumulative AF burden ≥6 h in a day. Sixteen patients in AF at the time of implantation were excluded from our analysis. During follow-up, AF burden ≥6 h/day was documented in 35 (24%) of the patients included in the analysis and in 12 (13%) of the 96 patients with no history of AF. Severe SA was detected in 89 patients during the first week after implantation; 58 of these had no history of AF. Severe SA at the baseline was associated with a higher risk of AF both in the whole population (log-rank test, hazard ratio: 2.38; 95% CI: 1.21-4.66; P = 0.025) and among patients with no previous history of AF (log-rank test, hazard ratio: 2.80; 95% CI: 1.10-7.10; P = 0.047). Moreover, severe SA at the time of follow-up device interrogation predicted AF occurrence within the next 3 months (log-rank test, hazard ration: 2.13; 95% CI: 1.11-4.08; P = 0.036).
  
  
  CONCLUSIONS
  In pacemaker patients, device-diagnosed severe SA was independently associated with a higher risk of AF (≥6 h/day) and new-onset AF. In particular, severe SA on follow-up data review identified patients who were ∼2-fold more likely to experience an AF episode in the next 3 months.
authors.affiliation: Cardiology Division, S. Maria della Stella Hospital, Località Ciconia, 05018 Orvieto (TR), Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Mazza
authors.affiliation: Cardiology Division, S. Maria della Stella Hospital, Località Ciconia, 05018 Orvieto (TR), Italy.
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Bendini
authors.affiliation: Cardiology Division, S. Maria della Stella Hospital, Località Ciconia, 05018 Orvieto (TR), Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: De Cristofaro
authors.affiliation: CRM Department, Boston Scientific Italy, Viale Forlanini 23, 20134 Milan, Italy.
authors.forename: Mariolina
authors.initials: M
authors.lastname: Lovecchio
authors.affiliation: CRM Department, Boston Scientific Italy, Viale Forlanini 23, 20134 Milan, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Valsecchi
authors.affiliation: Cardiology Department, University of Modena and Reggio Emilia, Policlinico di Modena, Viale del Pozzo, 71,41124 Modena, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Boriani
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000503:physiopathology; D002304:Cardiac Pacing, Artificial; D002307:Cardiography, Impedance / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D008297:Male; D010138:Pacemaker, Artificial; D011237:Predictive Value of Tests; D015656:Respiratory Mechanics; D012307:Risk Factors; D012720:Severity of Illness Index; D012815:Signal Processing, Computer-Assisted; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents
keywords: Atrial fibrillation; Pacemaker; Sleep apnea