Einfluss des obrstruktiven Schlafapnoesyndroms auf den interventionellen Therapieerfolg bei Vorhofflimmern

Association between obstructive sleep apnea and long term success of pulmonary vein ablation using remote magnetic navigation

by Lena Marie Hahnefeld
Doctoral thesis
Date of Examination:2014-02-25
Date of issue:2014-02-20
Advisor:PD Dr. Lars Lüthje
Referee:PD Dr. Lars Lüthje
Referee:Prof. Dr. Ralf Seipelt
Persistent Address: http://dx.doi.org/10.53846/goediss-4365

 

 

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Abstract

English

Association between obstructive sleep apnea and long term success of pulmonary vein ablation using remote magnetic navigation Backround: Pulmonary vein ablation (PVA) has become an established treatment choice for patients with drug-refractory symptomatic atrial fibrillation (AF). However, success rates still are limited. Influencing factors may comprise patients’ clinical characteristics and the ablation technique used. While the association of AF and obstructive sleep apnea (OSA) is well established, limited data exist on AF ablation efficacy in patients suffering from OSA. Objective: In a prospective series we aimed to investigate the influence of OSA on PVA results using remote magnetic navigation (RMN) for the guidance of the ablation catheter. Methods: Patients referred to our hospital between 12/08 und 08/10 with standard indication for PVA were tested for OSA using an unattended polygraphy (Stardust II, Respironics) after written informed consent. The polygraphy was analysed manually. OSA was diagnosed, if the apnea-hypopnea index (AHI) was ≥10/h with predominately obstructive episodes. Patients with a predominately central sleep apnea syndrome were excluded (n=18). Patients with an AHI<10/h served as control group. PVA was performed using RMN and an electro-anatomic mapping system (CARTO). All subjects were followed every three months by 7d Holter-ECG. Furthermore, all patients were advised to present immediately in case of symptoms suggestive for arrhythmia recurrence and obtain ECG documentation. Results: OSAS was diagnosed in 56 of 102 Patients. 28 Patients had an AHI <10/h. Patients with or without OSAS were equivalent in gender, age and left atrial diameter. Both groups differed significantly in body mass index. After a following period of one year Kaplan-Meier analysis has shown a significantly different AF recurrence rate for the OSA and control group (p=0.04). Cox-Regression has identified the body mass index as the most important predictor of recurrent AF after PVA. Conclusion Untreated obstructive sleep apnea negatively influences long-term success rates of remote magnetic navigation guided pulmonary vein ablation, but BMI was identified as the most important predictor of recurrent AF after PVA.
Keywords: atrial fibrillation; obstructive sleep apnea; pulmonary vein ablation
 
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