Role of the Ambulatory Assessed Apnea-Hypopnea Index for Predicting Recurring Atrial Fibrillation After Ablation Therapy.

Abstract

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.