Background: Obstructive sleep aponea (OSA) is associated with an increasingly remodeled atrial substrate in atrial fibrillation (AF). Management of OSA has been linked with improved AF treatment outcomes. However, the impact of OSA management on the atrial substrate has not been evaluated.
Objective: To evaluate the impact of OSA management on the atrial substrate for AF.
Methods: We recruited 24 patients having catheter ablation for AF with at least moderate OSA (AHI ≥ 15). Participants were randomized in a 1:1 ratio to receive continuous positive airway pressure (CPAP) or no therapy. At baseline, all participants underwent invasive electrophysiologic study comprising high density right atrial mapping and evaluation of effective refractory periods (ERP). After minimum of 6 months, the electrophysiologic protocol was repeated. Data was blinded and analyzed. Outcome variables were atrial voltage (mV), conduction velocity (m/s), atrial surface area < 1.5mV (%), atrial surface area < 0.5mV (%), complex points (%) and atrial ERP (ms).
Results: There were no differences in baseline characteristics between groups and electrophysiologic parameters were comparable at baseline. Participants having CPAP were highly compliant (device usage: 79±19%, usage time: 268±91mins) resulting in significant AHI reduction (mean reduction: 31±23). There were no differences in blood pressure or body mass index between groups over time. The table presents data showing that CPAP results in marked reverse atrial remodeling.
Conclusion: CPAP therapy results in reversal of atrial remodeling, providing mechanistic evidence advocating for management of OSA in AF. (Trial registration: ACTRN12616000088448)