Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany; Deutsches Zentrum für Herz- Kreislauf-Forschung (DZHK), Partner Site Munich Heart Alliance, Munich, Germany.
Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany.
Am J Cardiol. 2021 Jun 15;149:36-41. doi: 10.1016/j.amjcard.2021.03.029. Epub 2021 Mar 20.
Catheter ablation is an effective treatment for atrial fibrillation (AF). Obstructive sleep apnea (OSA) is a known risk factor for recurrent AF. The apnea-hypopnea index (AHI) is a measurement tool to screen patients for OSA. We sought to evaluate if the ambulatory assessed AHI is associated with AF recurrence following AF catheter ablation. 187 patients with paroxysmal (n = 155) or early persistent (n = 32) AF presenting for catheter ablation were included in the study. AHI was determined prior to ablation using an ambulatory screening device. All patients underwent pulmonary vein isolation (PVI). In patients with early persistent AF (17%) additional ablation of complex fractionated atrial electrograms (CFAE) was performed. Clinical follow-up was available after 3 and 12 months including 7-day Holter-ECG. All 187 patients (60.3 ± 11.4 years, 64.2% male) completed the 3 months follow-up and 170 patients the 12 months follow-up. A pathological AHI ≥15 was found in 45/187 (24.1%) patients. Additional CFAE did not differ between patients with an AHI ≥15 and AHI <15 (p = 0.663). After 3 months, 12/41 (29.3%) patients with AHI ≥15 showed recurrent AF compared to 24/146 (16.4%) patients with AHI <15 (p = 0.066). After 12 months, AHI ≥15 was associated with a significant higher rate of AF recurrence of 47.4% (18/38) versus 26.5% (35/132) in patients with AHI <15 (p = 0.014). In the logistic regression analysis AHI ≥15 was an independent predictor of recurrent AF at 12 months (p = 0.011). In conclusion, ambulatory assessed AHI ≥15 is associated with increased risk for AF recurrence following catheter ablation. OSA screening should be performed in AF patients as it might influence catheter ablation success.
导管消融是治疗心房颤动 (AF) 的有效方法。阻塞性睡眠呼吸暂停 (OSA) 是复发性 AF 的已知危险因素。呼吸暂停低通气指数 (AHI) 是筛查 OSA 患者的一种测量工具。我们旨在评估动态评估的 AHI 是否与 AF 导管消融后 AF 的复发有关。 187 例阵发性 (n=155) 或早期持续性 (n=32) AF 患者接受导管消融治疗，包括在该研究中。使用动态筛查设备在消融前确定 AHI。所有患者均接受肺静脉隔离 (PVI)。对于早期持续性 AF (17%) 的患者，还进行了复杂碎裂心房电图 (CFAE) 的消融。临床随访在 3 个月和 12 个月时进行，包括 7 天 Holter-ECG。所有 187 例患者 (60.3±11.4 岁，64.2%为男性) 完成了 3 个月的随访，170 例患者完成了 12 个月的随访。187 例患者中有 45 例 (24.1%) 的 AHI≥15。在 AHI≥15 和 AHI<15 的患者之间，额外的 CFAE 没有差异 (p=0.663)。3 个月时，41 例 AHI≥15 的患者中有 12 例 (29.3%) 出现复发性 AF，而 146 例 AHI<15 的患者中有 24 例 (16.4%) 出现复发性 AF (p=0.066)。12 个月时，AHI≥15 与 AF 复发的显著更高发生率相关，47.4% (18/38) 与 AHI<15 的患者的 26.5% (35/132) 相比 (p=0.014)。在逻辑回归分析中，AHI≥15 是 12 个月时复发性 AF 的独立预测因子 (p=0.011)。总之，动态评估的 AHI≥15 与导管消融后 AF 复发的风险增加相关。应在 AF 患者中进行 OSA 筛查，因为它可能影响导管消融的成功率。
