Duke Center for Atrial Fibrillation, Duke University Hospital, Durham, NC, USA.
Electrophysiology Section, Duke Clinical Research Institute, Pratt Street, Durham, NC, USA.
Europace. 2018 Nov 1;20(FI_3):f337-f342. doi: 10.1093/europace/eux248.
To assess whether obstructive sleep apnea (OSA) was associated with increased rotor burden among atrial fibrillation (AF) patients.
We studied 33 consecutive patients who were scheduled for focal impulse and rotor modulation (FIRM) ablation at our institution to describe the mapping, ablation, and outcomes, among patients with and without OSA. Patients underwent biatrial FIRM mapping in AF with ablation of stable rotors in addition to conventional ablation lesion sets. Differences between groups were tested with student's t-tests and Fisher's exact tests, as appropriate. Survival analyses were performed using the Kaplan-Meier method. Twelve of the 33 (36%) patients had OSA and 8 (66%) used continuous positive airway pressure ventilation (CPAP). Obstructive sleep apnea patients had a higher body mass index (BMI) (33.6 vs. 28.8 kg/m2, P = 0.01) and were more commonly on beta blockers (67% vs. 29%, P = 0.03) but were otherwise similar regarding baseline characteristics, medication use, and prior AF treatments, including antiarrhythmic drugs and prior ablation. Focal impulse and rotor modulation mapping demonstrated increased rotor burden in the OSA patients (2.6 ± 0.9 vs. 2.0 ± 1.0, P =0.03). The increased rotor burden was more evident in the right atrium (RA) (1.0 ± 0.7 vs. 0.5 ± 0.7, P =0.04 compared with left atrium (1.7 ± 0.8 vs. 1.4 ± 0.7, P = 0.15). There was no correlation between BMI and total number of rotors (r = 0.0961, P = 0.59). Among the population of patients with OSA, CPAP therapy was associated with a lower number of RA rotors (0.8 ± 0.7 vs. 1.5 ± 0.6, P = 0.05) but no significant difference in overall rotors (P = 0.33).
Obstructive sleep apnea patients demonstrate increased rotor prevalence, driven predominantly by an increase in RA rotors. CPAP therapy was associated with fewer RA rotors.
评估阻塞性睡眠呼吸暂停（OSA）是否与心房颤动（AF）患者的转子负荷增加有关。
我们研究了 33 例连续患者，他们在我院接受局灶性冲动和转子调制（FIRM）消融治疗，以描述有和无 OSA 患者的映射、消融和结果。在 AF 中进行双房 FIRM 映射，除了常规消融损伤集外，还消融稳定的转子。使用学生 t 检验和 Fisher 确切检验测试组间差异，视情况而定。使用 Kaplan-Meier 方法进行生存分析。33 例患者中有 12 例（36%）患有 OSA，8 例（66%）使用持续气道正压通气（CPAP）。阻塞性睡眠呼吸暂停患者的体重指数（BMI）较高（33.6 比 28.8kg/m2，P=0.01），β受体阻滞剂的使用率更高（67%比 29%，P=0.03），但其他基线特征、药物使用和先前的 AF 治疗（包括抗心律失常药物和先前的消融）相似。局灶性冲动和转子调制映射显示 OSA 患者的转子负荷增加（2.6±0.9 比 2.0±1.0，P=0.03）。右心房（RA）的转子负荷增加更为明显（1.0±0.7 比 0.5±0.7，P=0.04 与左心房（1.7±0.8 比 1.4±0.7，P=0.15）相比）。BMI 与总转子数之间无相关性（r=0.0961，P=0.59）。在 OSA 患者人群中，CPAP 治疗与 RA 转子数量减少相关（0.8±0.7 比 1.5±0.6，P=0.05），但总转子数无显著差异（P=0.33）。
阻塞性睡眠呼吸暂停患者表现出更高的转子发生率，主要是由 RA 转子增加引起的。CPAP 治疗与较少的 RA 转子相关。
