Sleep Apnea and Atrial Fibrillation

Continuous Positive Airway Pressure Treatment Decreases the Risk of Atrial Fibrillation Recurrence in Patients with Obstructive Sleep Apnea after Radiofrequency Ablation

This study aimed to determine the effect of continuous positive airway pressure (CPAP) therapy on patients with atrial fibrillation (AF) and obstructive sleep apnea (OSA) after radiofrequency ablation (RFCA).OSA predicts recurrence of AF in patients with AF and OSA after RFCA. However, the effect of CPAP therapy on recurrence of AF in these patients after RFCA is poorly known.All 122 patients who underwent RFCA from 2017 to 2020 were diagnosed OSA by polysomnography. A total of 62 patients were treated by CPAP, while the remaining 60 were not treated by CPAP. The recurrence of atrial tachyarrhythmia and use of antiarrhythmic drugs were compared between the two groups during a follow-up of 12 months. The outcome of these patients with OSA was compared to a group of 60 AF patients undergoing RFCA without OSA.Patients undergoing CPAP therapy had a higher AF-free survival rate compared to non-CPAP-treated patients (70.3% versus 31.5%; P = 0.02). LAD was associated with the risk of AF recurrence in patients with OSA (HR per mm increase: 1.0; 95% CI: 1.06-1.21; P = 0.01). The CPAP nonusers had more than two-fold increased risk of AF recurrence following pulmonary vein isolation (HR: 2.37; 95% CI: 1.21-4.96; P = 0.02).CPAP treatment highly increased arrhythmia-free survival in AF patients accompanied by OSA after RFCA and reduced recurrence of AF in these patients.

Life's Simple 7 Approach to Atrial Fibrillation Prevention

Atrial fibrillation (AF) is the most commonly encountered arrhythmia in clinical practice. It constitutes a major public health problem, with total related annual expenses estimated at $6.65 billion. The American Heart Association developed Life's Simple 7 (LS7) to define and monitor ideal cardiovascular health (CVH). In this review, we examine the role of individual components of LS7 to provide further insight regarding potential influence of achieving AHA's strategic goal on AF prevention. While significant advances have been made in the secondary prevention of AF, little progress has been made to prevent the first occurrence of this arrhythmia in at-risk patients. Improvement of overall cardiovascular health as defined by LS7 may substantially reduce AF risk.

Atrial fibrillation among patients under investigation for suspected obstructive sleep apnea

Study objectives

Obstructive sleep apnea is common among patients with atrial fibrillation, but the prevalence and risk factors for atrial fibrillation among patients who are being investigated on suspicion of sleep apnea are not well known. The aim of the study was to estimate the prevalence of atrial fibrillation among patients investigated for suspected obstructive sleep apnea and to identify risk factors for atrial fibrillation among them.

Methods

The prevalence of atrial fibrillation was investigated among 201 patients referred for suspected obstructive sleep apnea. Patients without known atrial fibrillation were investigated with a standard 12-lead ECG at hospital and short intermittent handheld ECG recordings at home, during 14 days.

Results

Atrial fibrillation occurred in 13 of 201 subjects (6.5%), and in 12 of 61 men aged 60 years and older (20%). The prevalence of atrial fibrillation increased with sleep apnea severity (p = 0.038). All patients with atrial fibrillation were men and all had sleep apnea. Age 60 or older, the occurrence of central sleep apnea and diabetes mellitus were independent risk factors for atrial fibrillation after adjustments for body mass index, gender, sleep apnea and cardiovascular disease.

Conclusions

Atrial fibrillation is common among subjects referred for sleep apnea investigation and the prevalence of atrial fibrillation increases with sleep apnea severity. Independent risk factors for atrial fibrillation among patients investigated for suspected obstructive sleep apnea include the occurrence of coexisting central sleep apnea, age 60 years or older and diabetes mellitus.

Evaluating the benefits of home-based management of atrial fibrillation: current perspectives

Atrial fibrillation (AF) is the most common arrhythmia worldwide, leading to an extensive public health and economic burden. The increasing incidence and prevalence of AF is due to the advancing age of the population, structural heart disease, hypertension, diabetes, and thyroid disease. The majority of costs associated with AF have been attributed to the cost of hospitalization. In order to minimize costs and decrease hospitalizations, counseling on modifiable risk factors contributing to AF has been strongly emphasized. With the release of novel oral anticoagulants bypassing the need for anticoagulant bridging or laboratory monitoring, post-discharge nurse-led home intervention, and novel methods of heart rate monitoring, home-based AF management has reached a new level of ease and sophistication. In this review, we aimed to review modifiable risk factors for AF and various methods of home-based management of AF, along with their benefits.

Atrial Fibrillation: The Science behind Its Defiance

Atrial fibrillation (AF) is the most prevalent arrhythmia in the world, due both to its tenacious treatment resistance, and to the tremendous number of risk factors that set the stage for the atria to fibrillate. Cardiopulmonary, behavioral, and psychological risk factors generate electrical and structural alterations of the atria that promote reentry and wavebreak. These culminate in fibrillation once atrial ectopic beats set the arrhythmia process in motion. There is growing evidence that chronic stress can physically alter the emotion centers of the limbic system, changing their input to the hypothalamic-limbic-autonomic network that regulates autonomic outflow. This leads to imbalance of the parasympathetic and sympathetic nervous systems, most often in favor of sympathetic overactivation. Autonomic imbalance acts as a driving force behind the atrial ectopy and reentry that promote AF. Careful study of AF pathophysiology can illuminate the means that enable AF to elude both pharmacological control and surgical cure, by revealing ways in which antiarrhythmic drugs and surgical and ablation procedures may paradoxically promote fibrillation. Understanding AF pathophysiology can also help clarify the mechanisms by which emerging modalities aiming to correct autonomic imbalance, such as renal sympathetic denervation, may offer potential to better control this arrhythmia. Finally, growing evidence supports lifestyle modification approaches as adjuncts to improve AF control.

Incidence and risk of atrial fibrillation in sleep-disordered breathing without coexistent systemic disease

BACKGROUND

Although the link between sleep-disordered breathing (SDB) and atrial fibrillation (AF) has been reported, a population-based longitudinal cohort study was lacking. The goal of the present study was to investigate the AF risk carried by SDB, using the National Health Insurance Research Database in Taiwan. METHODS AND RESULTS: From 2000 to 2001, a total of 579,521 patients who had no history of cardiac arrhythmias or significant comorbidities were identified. Among them, 4,082 subjects with the diagnosis of SDB were selected as the study group, and the remaining 575,439 subjects constituted the control group. The study endpoint was the occurrence of new-onset AF. During a follow-up of 9.2±2.0 years, there were 4,023 patients (0.7%) experiencing new-onset AF. The occurrence rate of AF was higher in patients with SDB compared to those without it (1.3% vs. 0.7%, P<0.001). The AF incidences were 1.38 and 0.76 per 1,000 person-years for patients with and without SDB, respectively. After anadjustment for age and sex, SDB was a significant risk factor of AF with a hazard ratio of 1.536. The AF risk increased with increasing clinical severity of SDB, represented by the requirement of continuous positive airway pressure use.

CONCLUSIONS

SDB itself, without the coexistence of other systemic diseases, was a risk factor of AF.

Atrial fibrillation in the 21st century: a current understanding of risk factors and primary prevention strategies

Atrial fibrillation (AF) is the most common arrhythmia worldwide, and it has a significant effect on morbidity and mortality. It is a significant risk factor for stroke and peripheral embolization, and it has an effect on cardiac function. Despite widespread interest and extensive research on this topic, our understanding of the etiology and pathogenesis of this disease process is still incomplete. As a result, there are no set primary preventive strategies in place apart from general cardiology risk factor prevention goals. It seems intuitive that a better understanding of the risk factors for AF would better prepare medical professionals to initially prevent or subsequently treat these patients. In this article, we discuss widely established risk factors for AF and explore newer risk factors currently being investigated that may have implications in the primary prevention of AF. For this review, we conducted a search of PubMed and used the following search terms (or a combination of terms): atrial fibrillation, metabolic syndrome, obesity, dyslipidemia, hypertension, type 2 diabetes mellitus, omega-3 fatty acids, vitamin D, exercise toxicity, alcohol abuse, and treatment. We also used additional articles that were identified from the bibliographies of the retrieved articles to examine the published evidence for the risk factors of AF.

Race-specific impact of atrial fibrillation risk factors in blacks and whites in the southern community cohort study

Despite a greater burden of traditional risk factors, atrial fibrillation (AF) is less common among blacks than whites for reasons that are unclear. The aim of this study was to examine race- and gender-specific influences of demographic, lifestyle, anthropometric, and medical factors on AF in a large cohort of blacks and whites. Among white and black participants in the Southern Community Cohort Study (SCCS) aged ≥65 years receiving Medicare coverage from 1999 to 2008 (n = 8,836), diagnoses of AF (International Classification of Diseases, Ninth Revision, Clinical Modification code 427.3) were ascertained. Multivariate logistic regression was used to compute AF odds ratios associated with participant characteristics, including histories of hypertension, diabetes, stroke, and myocardial infarction or coronary artery bypass graft surgery, ascertained at cohort entry. Over an average of 5.7 years of Medicare coverage, AF was diagnosed in 1,062 participants. AF prevalence was significantly lower among blacks (11%) than whites (15%) (p <0.0001). Odds ratios for AF increased with age and were higher among men, the tall and obese, and patients with each of the co-morbid conditions, but the AF deficit among blacks compared to whites persisted after adjustment for these factors (odds ratio 0.64, 95% confidence interval 0.55 to 0.73). The patterns of AF risk were similar for blacks and whites, although associations with hypertension, diabetes, and stroke were somewhat stronger among blacks. In conclusion, these findings confirm the lower prevalence of AF among blacks than whites and suggest that traditional risk factors for AF apply similarly to the 2 groups and thus do not appear to explain the AF paradox in blacks.

Differential impact of race and risk factors on incidence of atrial fibrillation

Despite some common risk factors for atrial fibrillation (AF) being more prevalent among blacks, African Americans are increasingly being reported with lower prevalence and incidence of AF compared with whites. Contemporary studies have not provided a complete explanation for this apparent AF paradox in African Americans. Although many traditional and novel risk factors for AF have been identified, the role of ethnic-specific risk factors has not been examined. Whereas hypertension has been the most common risk factor associated with AF, coronary artery disease also plays an important role in AF pathophysiology in whites. Thereby, elucidating the role of ethnic-specific risk factors for AF may provide important insight into why African Americans are protected from AF or why whites are more prone to develop the arrhythmia. The link between AF susceptibility and genetic processes has only been recently uncovered. Polymorphisms in renin-angiotensin system genes have been characterized as predisposing to AF under certain environmental conditions. Several ion channel genes, signaling molecules, and several genetic loci have been linked with AF. Thereby, studies investigating genetic variants contributing to the differential AF risk in individuals of African American versus European ancestry may also provide important insight into the etiology of the AF paradox in blacks.

Correlative anatomy for the electrophysiologist: ablation for atrial fibrillation. Part I: pulmonary vein ostia, superior vena cava, vein of Marshall

Ablation procedures for atrial fibrillation (AF) have become an established and increasingly used option for managing patients with symptomatic arrhythmia. The anatomic structures relevant to the pathogenesis of AF and ablation procedures are varied and include the pulmonary veins (PVs), other thoracic veins, the left atrial myocardium, and autonomic ganglia. Exact regional anatomic knowledge of these structures is essential to allow correlation with fluoroscopy and electrograms, and, importantly, to avoid complications from damage of adjacent structures within the chest. We have presented this information in a 2-part series. In the present article, we examine the general anatomic characteristics of the PVs, superior vena cava, and vein of Marshall. Features of particular relevance for the invasive electrophysiologist are pointed out. In a subsequent article, we discuss the regional anatomy of the left and right atria and anatomic considerations in preventing complications during AF ablation.