Somers - Figure 43
Afib Recurrence after PVI is Attenuated with CPAP
FIG. 43: Another way to look at whether treating OSA will influence the recurrence of AF comes from patients treated with a more advanced approach than simple cardioversion. This Figure reports data showing that untreated sleep apnea is linked to a higher likelihood of AF recurrence not only after cardioversion, but also after pulmonary vein isolation (PVI).[33]
PVI is an advanced catheter ablation technique that is being more and more widely used to treat patients with AF. These data are from patients with OSA who were or were not treated with CPAP and who then underwent PVI. The result was that survival free from recurrence of AF is significantly higher in the patients with OSA treated with CPAP than in the patients with OSA who did not receive CPAP therapy.
Looking at the hazard ratio, it is apparent that the left atrial diameter has an important effect on the likelihood of recurrence, but nonetheless, it is also clear that for patients with sleep apnea treated with CPAP the likelihood of AF recurrence is 0.7, whereas if they are not treated with CPAP hazard ratio for recurrence is 3 times greater, at 2.1.
Thus these observational data suggest that if a patient’s AF is treated but the patient’s OSA is not treated, the AF is more likely to recur, although again, randomized controlled clinical trials are need to demonstrate this suggestion definitively before physicians can incorporate this disease management principle into standard of care.
References
Fein AS, Shvilkin A, Shah D, et al. Treatment of obstructive sleep apnea reduces the risk of atrial fibrillation recurrence after catheter ablation. J Am Coll Cardiol. 2013;62:300–305.
