HEART RHYTHM:阻塞性睡眠呼吸暂停升高房颤消融后复发率

　　日本学者的一项研究表明，伴有未治疗阻塞性睡眠呼吸暂停（OSA）的患者房颤射频消融后复发率较高；在OSA患者中适宜的持续气道正压（CPAP）治疗与房颤复发率降低相关。论文于2012年11月26日在线发表于《心律》（Heart Rhythm）杂志。

　　此项研究共纳入153例因耐药性房颤而接受广泛环肺静脉电隔离的患者[（男性128例，年龄为（60±9）岁]。在射频消融1周后进行标准多导睡眠监测评估，并记录中枢性或OSA或低通气发作次数和总持续时间。

　　结果显示，116例患者被确认伴有OSA。82例患者具有CPAP应用和房颤复发的数据；其余34例OSA患者被定义为非CPAP组。多导睡眠监测显示37例患者无睡眠障碍性呼吸。在平均随访（18.8±10.3）个月期间，51例（33%）患者在消融后出现房颤复发。Cox回归分析显示，在随访期间左房容积、伴发OSA和CPAP治疗应用与房颤复发相关。

Concomitant obstructive sleep apnea increases the recurrence of atrial fibrillation following radiofrequency catheter ablation of atrial fibrillation: clinical impact of continuous positive airway pressure therapy

BACKGROUND

Recent studies have suggested an emerging link between obstructive sleep apnea (OSA) and atrial fibrillation (AF). Patients with OSA are less likely to remain in sinus rhythm after radiofrequency catheter ablation of AF.

OBJECTIVE

The aim of this study was to evaluate the efficacy of appropriate treatment with continuous positive airway pressure (CPAP) on recurrences of AF after ablation.

METHODS

This study prospectively included 153 patients (128 men; 60±9 years) who underwent extensive encircling pulmonary vein isolation for drug refractory AF. The standard overnight polysomnographic evaluation was performed 1 week after the ablation, and the total duration and number of central or obstructive sleep apnea or hypopnea episodes were examined.

RESULTS

Out of 153 patients, 116 patients were identified as having OSA. Data regarding the use of CPAP and recurrences of AF were obtained in 82 patients. The remaining 34 OSA patients were defined as the no-CPAP group. The polysomnography revealed no sleep-disordered breathing in 37 patients. During a mean follow-up period of 18.8±10.3 months, 51 patients (33%) experienced AF recurrences after the ablation. A Cox regression analysis revealed that the left atrial volume (HR=1.11, 95% CI 1.01–1.23; p<0.05), concomitant OSA (HR=2.61, 95% CI 1.12–6.09; p<0.05), and usage of CPAP therapy (HR=0.41, 95% CI 0.22–0.76, p<0.01) were associated with AF recurrences during the follow-up period.

CONCLUSIONS

Patients with untreated OSA have a higher recurrence of AF after the ablation. Appropriate treatment with CPAP in OSA patients is associated with a lower recurrence of AF.