Abstract 14169: Aggressive Life-style Modifications Facilitate Arrhythmia-free Survival in Atrial Fibrillation Patients With Coexistent Metabolic Syndrome and Sleep Apnea Having Sporadic Recurrence Following First Ablation Procedure
Background: Metabolic syndrome (MS) and obstructive sleep apnea (OSA) are well-known independent risk factors for AF recurrence. This study evaluated long-term ablation-outcome in AF patients with coexistent MS and OSA and influence of life-style modifications (LSM) on arrhythmia-recurrence.
Method: We included 1257 AF patients undergoing first catheter ablation [32% paroxysmal AF]. Patients having both MS and OSA were classified into Group 1(n=126, 64±8 years, 77% male) and Group 2 included those with either MS or OSA or neither of these comorbidities (n=1131, 62±11 years, 72% male). Of the 1131 patients in group 2, 431 (38%) had only MS, 112 (10%) had only OSA (no CPAP-users) and 588 were without OSA or MS. Patients with recurrence after first procedure were divided into two subgroups; those having sporadic events remained on previously ineffective AAD and aggressive LSM (diet and exercise), those with persistent arrhythmia underwent repeat ablation. They were followed-up for 20±6 months.
Result: At 34±8 months of follow-up after first procedure, 66(52%) in group 1 and 386 (34%) in group 2 had recurrence (p=<0.001). Recurrence rate in only-MS, only-OSA and without MS/OSA groups were 40%, 38% and 29% respectively. Patients with MS+OSA, experienced substantially higher recurrence compared to those with lone MS or OSA (52% vs. 40% vs. 38%, p <0.036). Of the 452 patients (group 1, 66; group 2, 386) having recurrence, 250 underwent redo-ablation and 194 remained on AAD+LSM. During redo, PV reconnection and non-PV triggers were detected in 1.8% and 100% patients respectively and were reablated. At 20±6 months, 190 (76%) of the redo group remained arrhythmia-free, all off AAD and 74% of the LSM group were recurrence-free (p=0.71) with 33% being off AAD.
Conclusions: MS and OSA have additive negative effect on arrhythmia-recurrence following single procedure. In patients with recurrence, either repeat ablation focusing on non-PV triggers or compliance to life-style modifications increase freedom from recurrent AF.
- © 2013 by American Heart Association, Inc.