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COMPARATIVE STUDY
JOURNAL ARTICLE
MULTICENTER STUDY

Safety and efficacy of pulmonary vein antral isolation in patients with obstructive sleep apnea: the impact of continuous positive airway pressure

Dimpi Patel, Prasant Mohanty, Luigi Di Biase, Mazen Shaheen, William R Lewis, Kara Quan, Jennifer E Cummings, Paul Wang, Amin Al-Ahmad, Preeti Venkatraman, Eyad Nashawati, Dhanunjaya Lakkireddy, Robert Schweikert, Rodney Horton, Javier Sanchez, Joseph Gallinghouse, Steven Hao, Salwa Beheiry, Deb S Cardinal, Jason Zagrodzky, Robert Canby, Shane Bailey, J David Burkhardt, Andrea Natale
Circulation. Arrhythmia and Electrophysiology 2010, 3 (5): 445-51
20689107

BACKGROUND: Obstructive sleep apnea (OSA) may be associated with pulmonary vein antrum isolation (PVAI) failure. The aim of the present study was to investigate if treatment with continuous positive airway pressure (CPAP) improved PVAI success rates.

METHODS AND RESULTS: From January 2004 to December 2007, 3000 consecutive patients underwent PVAI. Patients were screened for OSA and CPAP use. Six hundred forty (21.3%) patients had OSA. Patients with OSA had more procedural failures (P=0.024) and hematomas (P<0.001). Eight percent of the non-OSA paroxysmal atrial fibrillation patients had nonpulmonary vein antrum triggers (non-PV triggers) and posterior wall firing versus 20% of the OSA group (P<0.001). Nineteen percent of the non-OSA nonparoxysmal atrial fibrillation population had non-PV triggers versus 31% in the OSA group (P=0.001). At the end of the follow-up period (32±14 months), 79% of the non-CPAP and 68% of the CPAP group were free of atrial fibrillation (P=0.003). Not using CPAP in addition to having non-PV triggers strongly predicted procedural failure (hazard ratio, 8.81; P<0.001).

CONCLUSIONS: OSA was an independent predictor for PVAI failure. Treatment with CPAP improved PVAI success rates. Patients not treated with CPAP in addition to having higher prevalence of non-PV triggers were 8 times more likely to fail the procedure.

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