Abstract Body (Do not enter title and authors here): Background: Previous literature suggests that Obstructive sleep apnea (OSA) increases atrial fibrillation (AF) recurrence after catheter ablation, but its impact on atrial remodeling has not been investigated.
Objective: The study assesses the impact of OSA and continuous positive airway pressure (CPAP) on atrial remodeling, AF burden, arrhythmia recurrence, QoL improvement.
Methods: The study population consists of patients with persistent AF with late-gadolinium enhancement (LGE) MRI before and after undergoing catheter ablation from the DECAAF II trial. We compared a subgroup with OSA with the rest of the cohort. The three study outcomes were measured with the following: arrhythmia recurrence and AF Burden based on single-lead smartphone-based daily electrocardiogram (ECG) strips, and SF36 questionnaires (baseline, 3-month, 12 month). Survival analysis of arrhythmia recurrence was performed using cox regression analysis, controlling for confounders.
Results: The study population consists of 815 patients. We compared 84 OSA patients with the remaining 731 non-OSA population. Amongst OSA patients 29 patients were treated with CPAP. Baseline characteristics including baseline fibrosis (18.8 vs 18.86; p=0.9426), left atrial volume index (LAVI) (62.4 mm³ vs 62.6 mm³ p=0.95), and comorbidities were not different between OSA and non-OSA patients except for body mass index (30.9 vs 35.1; p<0.001). OSA patients had more lateral fibrosis compared to non-OSA patients (2.6 vs 2.18; p=0.002). Both groups demonstrated equivalent LAVI decrease (9.5 mm³ vs 9.57 mm³; p=0.975), QoL improvement (11.8 vs 8.23; p=0.116), AF burden (14.8%vs 14.2% p-value=0.8222), and time-to-recurrence (p= 0.15). OSA is not associated in this cohort of persistent AF with ablation failure even after controlling for age, sex, body mass index (BMI), CPAP use, baseline fibrosis, and LAVI.
Conclusion: Catheter ablation for AF results in similar improvements in atrial remodeling, QoL, AF burden, and arrhythmia recurrence for both OSA and non-OSA patients, irrespective of CPAP treatment.