Systematic virtual sleep apnoea management in patients with atrial fibrillation undergoing catheter ablation: outcomes on atrial fibrillation symptom severity
K Betz, M Skrzypek, D V M Verhaert, M Gawalko, A Hermans, Z Habibi, M Engels, E Sandgren, S M Chaldoupi, T A R Langveld, A K Rahm, U Schotten, J Hendriks, K Vernooy, D LinzAbstract
Background
Sleep-disordered breathing (SDB) is highly prevalent in patients with atrial fibrillation (AF). Diagnosis and treatment of SDB can positively impact AF rate and rhythm control strategies.
Purpose
We present changes in AF symptom severity in patients undergoing catheter ablation (CA) who were enrolled in a systematic virtual SDB management pathway.
Methods
Patients scheduled for AF CA were systematically referred to a virtual sleep clinic (Virtual -SAFARI). Patients used a portable SDB testing device for one night at their homes. Recordings were uploaded to a secure cloud and accessed by a board-certified sleep physician. Severity of SDB was defined according to the apnoea-hypopnoea index (AHI), with moderate-to-severe SDB as AHI ≥ 15. SDB treatment was initiated, if necessary, including positive airway pressure (PAP), mandibular repositioning appliances (MRA) and sleep position training (SPT). Patients were followed up for up to 12 months after AF CA, including AF recurrences and assessment of severity of AF-related symptoms (Toronto AF Severity Scale [AFSS]). The minimal clinically relevant impact was considered a reduction in AFSS of at least 3 points (AFSS responders).
Results
A total of 290 patients were analyzed. More than half of the patients (50.7%) had diagnosed moderate-to-severe SDB. In 86.4% of these patients, treatment for SDB was initiated. Of these, 64 (39.3%) received PAP therapy, 74 (45.4%) received MRA, and 25 (15.3%) SPT. A total of 89 (30.6%) patients had AF recurrences after blanking period. A total of 220 (75.9%) patients completed the AFSS questionnaire at follow-up. AF symptoms improved after AF ablation in the overall cohort (11 [6-17] points at baseline to 5 [2-10] at 12 months, p < 0.001), both in patients with SDB (11 [6-17] points to 4 [1-9], p < 0.001) and without SDB (11 [6-18] points to 6 [2-12], p < 0.001). Similar improvements were seen in patients with AF recurrences (13 [6-18] points to 8 [3-15], p < 0.001) and without AF recurrences (10 [6-17] points to 5 [1-8], p < 0.001). A total of 133 (60.5%) patients were considered AFSS responders. In a final binary regression model, which included SDB diagnosis and treatment, as well as clinically relevant variables (age, gender, Montreal Cognitive Assessment [MoCA] score, redo-ablation, AF recurrences after ablation, previous electrical cardioversion), only the MoCA score at baseline (OR 0.856, 95% CI 0.757-0.967, p = 0.012) and SDB diagnosis with initiated treatment (OR 1.882, 95% CI 1.005-3.523, p = 0.048) were statistically significant determinants for AFSS responders.
Conclusion
Systematic virtual SDB management led to a high number of patients with newly detected and a high percentage of treated SDB cases. AF ablation improved AF symptoms in patients with and without SDB, as well as with and without AF recurrences. Patients with SDB and initiated SBD treatment were more likely to reach a clinically significant reduction (improvement) in AFSS.