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Circulation: Arrhythmia and Electrophysiology
This study characterizes the atrial substrate, including atrial fibrillation triggers in patients with paroxysmal atrial fibrillation and obstructive sleep apnea. They find that obstructive sleep apnea in patients with paroxysmal atrial fibrillation is associated with biatrial structural remodeling and increased incidence of extrapulmonary vein triggers.
Atrial Substrate and Triggers of Paroxysmal Atrial Fibrillation in Patients With Obstructive Sleep Apnea
Elad Anter, MD
Luigi Di Biase, MD, PhD
Fernando M. Contreras-Valdes, MD
Carola Gianni, MD, PhD
Sanghamitra Mohanty, MD
Cory M. Tschabrunn, PhD
Juan F. Viles-Gonzalez, MD
Eran Leshem, MD
Alfred E. Buxton, MD
Guy Kulbak, MD
Rim N. Halaby, MD
Peter J. Zimetbaum, MD
Jonathan W. Waks, MD
Robert J. Thomas, MD, MMSc
Andrea Natale, MD
Mark E. Josephson, MD
Correspondence to: Elad Anter, MD, Harvard-Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center, 185 Pilgrim Rd, Baker 4, Boston, MA 02215. E-mail email@example.com
BACKGROUND: Obstructive sleep apnea (OSA) is associated with atrial remodeling, atrial fibrillation (AF), and increased incidence of arrhythmia recurrence after pulmonary vein (PV) isolation. We aimed to characterize the atrial substrate, including AF triggers in patients with paroxysmal AF and OSA.
METHODS AND RESULTS: In 86 patients with paroxysmal AF (43 with ≥moderate OSA [apnea–hypopnea index ≥15] and 43 without OSA [apnea–hypopnea index <5]), right atrial and left atrial voltage distribution, conduction velocities, and electrogram characteristics were analyzed during atrial pacing. AF triggers were examined before and after PV isolation and targeted for ablation. Patients with OSA had lower atrial voltage amplitude (right atrial, P=0.0005; left atrial, P=0.0001), slower conduction velocities (right atrial, P=0.02; left atrial, P=0.0002), and higher prevalence of electrogram fractionation (P=0.0001). The areas of atrial abnormality were consistent among patients, most commonly involving the left atrial septum (32/43; 74.4%). At baseline, the PVs were the most frequent triggers for AF in both groups; however, after PV isolation patients with OSA had increased incidence …