Efficacy of Catheter Ablation of Atrial Fibrillation in Patients With Obstructive Sleep Apnoea With and Without Continuous Positive Airway Pressure Treatment

A Meta-analysis of Observational Studies

Li Li; Zeng-wu Wang; Jie Li; Xing Ge; Li-zhu Guo; Ying Wang; Wei-hua Guo; Chen-xi Jiang; Chang-sheng Ma

Disclosures

Europace. 2014;16(9):1309-1314. 

In This Article

Abstract and Introduction

Abstract

Aims An association between obstructive sleep apnoea (OSA) and atrial fibrillation (AF) has been established. However, studies on the role of OSA in AF recurrence after catheter ablation have yielded conflicting results, and the effect of OSA treatment by continuous positive airway pressure (CPAP) on the success rate of AF catheter ablation is indeterminate. The aim of this meta-analysis was to investigate the rate of AF recurrence after catheter ablation in patients with AF with or without OSA and to evaluate the relationship between CPAP therapy and AF recurrence.

Methods and results We performed an online search and identified five studies involving 3743 patients with AF. Patients with OSA had a 31% greater risk of AF recurrence after catheter ablation than did patients without OSA [relative ratio (RR) = 1.31, P = 0.00], and this risk increased by 57% in patients with OSA not undergoing CPAP therapy (RR = 1.57, P = 0.00). However, CPAP users had a risk of AF recurrence similar to that of patients without OSA (RR = 1.25, P = 0.37), and this similarity was maintained even after the removal of study heterogeneity (RR = 0.99, P = 0.39).

Conclusion Obstructive sleep apnoea was associated with AF recurrence after catheter ablation. The efficacy of catheter ablation for AF was similar between patients without OSA and patients with OSA undergoing CPAP treatment.

Introduction

Recurrence of atrial fibrillation (AF) is becoming an important limitation in the treatment of AF after successful catheter ablation.[1–3] Many cardiologists have become interested in the causes of AF recurrence. Increasingly more studies have indicated that obstructive sleep apnoea (OSA) is correlated with AF and is one of the factors associated with AF recurrence after successful catheter ablation.[4–7] Gami et al.[6] showed that approximately half of the patients with AF had OSA, and that the association between OSA and AF was greater than the associations between OSA and other factors such as body mass index, neck circumference, and hypertension. Matiello et al.[1] found that 24% of patients with AF who underwent catheter ablation had some degree of OSA; the severity of OSA influenced the success of catheter ablation of AF, and OSA was an independent predictor of failed catheter ablation of AF. Moreover, some studies have evaluated the influence of OSA on the efficacy of catheter ablation, but the sample sizes in these studies were not large enough to accurately discern whether treatment with CPAP mitigated the effects of OSA on the outcome of catheter ablation of AF.[1,8,9] Because of these uncertain conclusions, we investigated the efficacy of catheter ablation of AF in patients with OSA with or without CPAP treatment. The aim of this study was to reveal the association between CPAP therapy and AF recurrence after successful catheter ablation in patients with OSA.

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