1. Κολπικη μαρμαρυγη σε ασθενεις με αποφρακτικη υπνικη απνοια
Σωκράτης Παστρωμάς
Επιμελητής Α΄
Τμήμα Ηλεκτροφυσιολογίας και Βηματοδότησης
Ερρίκος Ντυνάν Hospital Center

2. Disclosure information
None related to this presentation

3. Modifiable risk factors in atrial fibrillation
Can J Cardiol. 2017;33:

4. Conditions independently associated with AF
European Heart Journal (2016) 37, 2893–2962

5. Definitions
Apnea is a reduction in airflow ≥90% of pre-event baseline for ≥10 seconds; hypopnea is a reduction in airflow ≥30%
Obstructive Sleep Apnea (OSA) , less common Central Sleep Apnea (CSA)
Apnea–hypopnea index (AHI): Number of apneas and hypopneas per hour of sleep
 AHI<5 events per hour sleep: normal, 5<AHI<15: mild, 15<AHI<30: moderate, AHI>30: severe
Prevalence: 9% of women & 24% of men aged yrs
OSA is a cause of systemic hypertension, and is associated with increased risk of stroke, heart failure, coronary artery disease and atrial fibrillation
EHRA POSITION PAPER 2017
Vasc Health Risk Manag. 2016;12:85-103, J Am Coll Cardiol. 2017;69:841–58

7. collapse of the upper airway
intrathoracic pressure swings
myocardial stretch of the heart particularly affecting the thin-walled atria
Sleep Med Rev. 2016;26:87-94

8. Atrial arrhythmogenic mechanisms during acute obstructive respiratory events
Sleep Med Rev. 2016;26:87-94

10. Regional bipolar voltages
OSA is associated with significant atrial remodeling characterized by atrial enlargement, reduction in voltage, site specific and widespread conduction abnormalities, and longer sinus node recovery
Heart Rhythm 2012;9:321–327

11. Obstructive Sleep Apnea and the Recurrence of Atrial Fibrillation after Cardioversion
 Circulation. 2003;107:

12. The presence of severe OSA is a powerful predictor of ablation failure, independently of atrial
enlargement, obesity, or hypertension that may co-exist in OSA patients.
Europace 2010: 12;1084–1089

13.  Am J Cardiol 2011; 108:47–51

14. J Interv Card Electrophysiol (2017) 50:1–55

15. Is CPAP therapy beneficial regarding lowering AF recurrences?

16. Impact of OSA and CPAP therapy on outcomes in patients with atrial fibrillation: ORBIT-AF
Patients with OSA on CPAP treatment were less likely to progress to more permanent forms of AF compared with patients without CPAP (HR, 0.66; 95% CI, ; P = .021)
Am Heart J 2015;169: e2

17. Treatment of Obstructive Sleep Apnea Reduces the
Risk of Atrial Fibrillation Recurrence
After Catheter Ablation
p=0.02
 PVI (+) OSA (+) CPAP (-) patients had more than
2-fold increased risk of AF recurrence
J Am Coll Cardiol 2013;62:300–5

18. Left atrial volume, OSA, CPAP usage: associated with AF recurrences
Heart Rhythm 2013;10:331–337 

19. 3000 pts underwent PVI, 640 (21%) had OSA
79%
68%

20. Am J Cardiol ;116:

21. Sleep Apnea Cardiovascular Endpoints (SAVE) study
N Engl J Med 2016;375:919-31
‘’Therapy with CPAP plus usual care did not prevent CV events in patients with moderate-to-severe obstructive sleep apnea and established cardiovascular disease’’

22. Take home messages… Strong evidence of an association between OSA & AF
Acute respiratory changes during apnea: triggers for AF (temporal association)
Chronic atrial remodeling process
CPAP may reduce AF recurrence after AF cardioversion or ablation
However, there is no strong data from large prospective RCTs support the beneficial effects of CPAP on AF recurrences