Effect of Sleep Apnea and Continuous Positive Airway Pressure on Cardiac Structure and Recurrence of Atrial Fibrillation

Background Sleep apnea (SA) is associated with an increased risk of atrial fibrillation (AF). We sought to determine the effect of SA on cardiac structure in patients with AF, whether therapy for SA was associated with beneficial cardiac structural remodelling, and whether beneficial cardiac structu...

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Veröffentlicht in:	Journal of the American Heart Association Jg. 2; H. 6; S. e000421 - n/a
Hauptverfasser:	Neilan, Tomas G., Farhad, Hoshang, Dodson, John A., Shah, Ravi V., Abbasi, Siddique A., Bakker, Jessie P., Michaud, Gregory F., Geest, Rob, Blankstein, Ron, Steigner, Michael, John, Roy M., Jerosch‐Herold, Michael, Malhotra, Atul, Kwong, Raymond Y.
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	England Blackwell Publishing Ltd 01.12.2013
Schlagworte:	Adult Aged Aged, 80 and over Arterial Pressure atrial fibrillation Atrial Fibrillation - diagnosis Atrial Fibrillation - epidemiology Atrial Fibrillation - physiopathology Atrial Fibrillation - surgery cardiac magnetic resonance Catheter Ablation Continuous Positive Airway Pressure Female Heart Atria - pathology Heart Atria - physiopathology Heart Ventricles - pathology Heart Ventricles - physiopathology Humans Incidence Magnetic Resonance Imaging Male Middle Aged Original Research Prospective Studies Pulmonary Veins - physiopathology Pulmonary Veins - surgery Recurrence Risk Factors sleep apnea Sleep Apnea, Obstructive - diagnosis Sleep Apnea, Obstructive - epidemiology Sleep Apnea, Obstructive - physiopathology Sleep Apnea, Obstructive - therapy Time Factors Treatment Outcome Ventricular Remodeling Young Adult cardiac magnetic resonance sleep apnea atrial fibrillation
ISSN:	2047-9980, 2047-9980
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Abstract	Background Sleep apnea (SA) is associated with an increased risk of atrial fibrillation (AF). We sought to determine the effect of SA on cardiac structure in patients with AF, whether therapy for SA was associated with beneficial cardiac structural remodelling, and whether beneficial cardiac structural remodelling translated into a reduced risk of recurrence of AF after pulmonary venous isolation (PVI). Methods and Results A consecutive group of 720 patients underwent a cardiac magnetic resonance study before PVI. Patients with SA (n=142, 20%) were more likely to be male, diabetic, and hypertensive and have an increased pulmonary artery pressure, right ventricular volume, atrial dimensions, and left ventricular mass. Treated SA was defined as duration of continuous positive airway pressure therapy of >4 hours per night. Treated SA patients (n=71, 50%) were more likely to have paroxysmal AF, a lower blood pressure, lower ventricular mass, and smaller left atrium. During a follow‐up of 42 months, AF recurred in 245 patients. The cumulative incidence of AF recurrence was 51% in patients with SA, 30% in patients without SA, 68% in patients with untreated SA, and 35% in patients with treated SA. In a multivariable model, the presence of SA (hazard ratio 2.79, CI 1.97 to 3.94, P<0.0001) and untreated SA (hazard ratio 1.61, CI 1.35 to 1.92, P<0.0001) were highly associated with AF recurrence. Conclusions Patients with SA have an increased blood pressure, pulmonary artery pressure, right ventricular volume, left atrial size, and left ventricular mass. Therapy with continuous positive airway pressure is associated with lower blood pressure, atrial size, and ventricular mass, and a lower risk of AF recurrence after PVI.
AbstractList	Sleep apnea (SA) is associated with an increased risk of atrial fibrillation (AF). We sought to determine the effect of SA on cardiac structure in patients with AF, whether therapy for SA was associated with beneficial cardiac structural remodelling, and whether beneficial cardiac structural remodelling translated into a reduced risk of recurrence of AF after pulmonary venous isolation (PVI).BACKGROUNDSleep apnea (SA) is associated with an increased risk of atrial fibrillation (AF). We sought to determine the effect of SA on cardiac structure in patients with AF, whether therapy for SA was associated with beneficial cardiac structural remodelling, and whether beneficial cardiac structural remodelling translated into a reduced risk of recurrence of AF after pulmonary venous isolation (PVI).A consecutive group of 720 patients underwent a cardiac magnetic resonance study before PVI. Patients with SA (n=142, 20%) were more likely to be male, diabetic, and hypertensive and have an increased pulmonary artery pressure, right ventricular volume, atrial dimensions, and left ventricular mass. Treated SA was defined as duration of continuous positive airway pressure therapy of >4 hours per night. Treated SA patients (n=71, 50%) were more likely to have paroxysmal AF, a lower blood pressure, lower ventricular mass, and smaller left atrium. During a follow-up of 42 months, AF recurred in 245 patients. The cumulative incidence of AF recurrence was 51% in patients with SA, 30% in patients without SA, 68% in patients with untreated SA, and 35% in patients with treated SA. In a multivariable model, the presence of SA (hazard ratio 2.79, CI 1.97 to 3.94, P<0.0001) and untreated SA (hazard ratio 1.61, CI 1.35 to 1.92, P<0.0001) were highly associated with AF recurrence.METHODS AND RESULTSA consecutive group of 720 patients underwent a cardiac magnetic resonance study before PVI. Patients with SA (n=142, 20%) were more likely to be male, diabetic, and hypertensive and have an increased pulmonary artery pressure, right ventricular volume, atrial dimensions, and left ventricular mass. Treated SA was defined as duration of continuous positive airway pressure therapy of >4 hours per night. Treated SA patients (n=71, 50%) were more likely to have paroxysmal AF, a lower blood pressure, lower ventricular mass, and smaller left atrium. During a follow-up of 42 months, AF recurred in 245 patients. The cumulative incidence of AF recurrence was 51% in patients with SA, 30% in patients without SA, 68% in patients with untreated SA, and 35% in patients with treated SA. In a multivariable model, the presence of SA (hazard ratio 2.79, CI 1.97 to 3.94, P<0.0001) and untreated SA (hazard ratio 1.61, CI 1.35 to 1.92, P<0.0001) were highly associated with AF recurrence.Patients with SA have an increased blood pressure, pulmonary artery pressure, right ventricular volume, left atrial size, and left ventricular mass. Therapy with continuous positive airway pressure is associated with lower blood pressure, atrial size, and ventricular mass, and a lower risk of AF recurrence after PVI.CONCLUSIONSPatients with SA have an increased blood pressure, pulmonary artery pressure, right ventricular volume, left atrial size, and left ventricular mass. Therapy with continuous positive airway pressure is associated with lower blood pressure, atrial size, and ventricular mass, and a lower risk of AF recurrence after PVI. Background Sleep apnea (SA) is associated with an increased risk of atrial fibrillation (AF). We sought to determine the effect of SA on cardiac structure in patients with AF, whether therapy for SA was associated with beneficial cardiac structural remodelling, and whether beneficial cardiac structural remodelling translated into a reduced risk of recurrence of AF after pulmonary venous isolation (PVI). Methods and Results A consecutive group of 720 patients underwent a cardiac magnetic resonance study before PVI. Patients with SA (n=142, 20%) were more likely to be male, diabetic, and hypertensive and have an increased pulmonary artery pressure, right ventricular volume, atrial dimensions, and left ventricular mass. Treated SA was defined as duration of continuous positive airway pressure therapy of >4 hours per night. Treated SA patients (n=71, 50%) were more likely to have paroxysmal AF, a lower blood pressure, lower ventricular mass, and smaller left atrium. During a follow‐up of 42 months, AF recurred in 245 patients. The cumulative incidence of AF recurrence was 51% in patients with SA, 30% in patients without SA, 68% in patients with untreated SA, and 35% in patients with treated SA. In a multivariable model, the presence of SA (hazard ratio 2.79, CI 1.97 to 3.94, P<0.0001) and untreated SA (hazard ratio 1.61, CI 1.35 to 1.92, P<0.0001) were highly associated with AF recurrence. Conclusions Patients with SA have an increased blood pressure, pulmonary artery pressure, right ventricular volume, left atrial size, and left ventricular mass. Therapy with continuous positive airway pressure is associated with lower blood pressure, atrial size, and ventricular mass, and a lower risk of AF recurrence after PVI. Sleep apnea (SA) is associated with an increased risk of atrial fibrillation (AF). We sought to determine the effect of SA on cardiac structure in patients with AF, whether therapy for SA was associated with beneficial cardiac structural remodelling, and whether beneficial cardiac structural remodelling translated into a reduced risk of recurrence of AF after pulmonary venous isolation (PVI). A consecutive group of 720 patients underwent a cardiac magnetic resonance study before PVI. Patients with SA (n=142, 20%) were more likely to be male, diabetic, and hypertensive and have an increased pulmonary artery pressure, right ventricular volume, atrial dimensions, and left ventricular mass. Treated SA was defined as duration of continuous positive airway pressure therapy of >4 hours per night. Treated SA patients (n=71, 50%) were more likely to have paroxysmal AF, a lower blood pressure, lower ventricular mass, and smaller left atrium. During a follow-up of 42 months, AF recurred in 245 patients. The cumulative incidence of AF recurrence was 51% in patients with SA, 30% in patients without SA, 68% in patients with untreated SA, and 35% in patients with treated SA. In a multivariable model, the presence of SA (hazard ratio 2.79, CI 1.97 to 3.94, P<0.0001) and untreated SA (hazard ratio 1.61, CI 1.35 to 1.92, P<0.0001) were highly associated with AF recurrence. Patients with SA have an increased blood pressure, pulmonary artery pressure, right ventricular volume, left atrial size, and left ventricular mass. Therapy with continuous positive airway pressure is associated with lower blood pressure, atrial size, and ventricular mass, and a lower risk of AF recurrence after PVI.
Author	Blankstein, Ron Kwong, Raymond Y. Shah, Ravi V. Bakker, Jessie P. Geest, Rob Dodson, John A. Farhad, Hoshang Malhotra, Atul Michaud, Gregory F. Steigner, Michael Abbasi, Siddique A. John, Roy M. Neilan, Tomas G. Jerosch‐Herold, Michael
Author_xml	– sequence: 1 givenname: Tomas G. surname: Neilan fullname: Neilan, Tomas G. organization: Massachusetts General Hospital – sequence: 2 givenname: Hoshang surname: Farhad fullname: Farhad, Hoshang organization: Brigham and Women's Hospital – sequence: 3 givenname: John A. surname: Dodson fullname: Dodson, John A. organization: Brigham and Women's Hospital – sequence: 4 givenname: Ravi V. surname: Shah fullname: Shah, Ravi V. organization: Massachusetts General Hospital – sequence: 5 givenname: Siddique A. surname: Abbasi fullname: Abbasi, Siddique A. organization: Brigham and Women's Hospital – sequence: 6 givenname: Jessie P. surname: Bakker fullname: Bakker, Jessie P. organization: Brigham and Women's Hospital – sequence: 7 givenname: Gregory F. surname: Michaud fullname: Michaud, Gregory F. organization: Brigham and Women's Hospital – sequence: 8 givenname: Rob surname: Geest fullname: Geest, Rob organization: Leiden University Medical Center – sequence: 9 givenname: Ron surname: Blankstein fullname: Blankstein, Ron organization: Brigham and Women's Hospital – sequence: 10 givenname: Michael surname: Steigner fullname: Steigner, Michael organization: Harvard Medical School – sequence: 11 givenname: Roy M. surname: John fullname: John, Roy M. organization: Brigham and Women's Hospital – sequence: 12 givenname: Michael surname: Jerosch‐Herold fullname: Jerosch‐Herold, Michael organization: Harvard Medical School – sequence: 13 givenname: Atul surname: Malhotra fullname: Malhotra, Atul organization: University of California San Diego – sequence: 14 givenname: Raymond Y. surname: Kwong fullname: Kwong, Raymond Y. organization: Brigham and Women's Hospital
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/24275628$$D View this record in MEDLINE/PubMed
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Copyright	2013 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell. 2013 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell. 2013
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Keywords	cardiac magnetic resonance sleep apnea atrial fibrillation
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Snippet	Background Sleep apnea (SA) is associated with an increased risk of atrial fibrillation (AF). We sought to determine the effect of SA on cardiac structure in... Sleep apnea (SA) is associated with an increased risk of atrial fibrillation (AF). We sought to determine the effect of SA on cardiac structure in patients...
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SubjectTerms	Adult Aged Aged, 80 and over Arterial Pressure atrial fibrillation Atrial Fibrillation - diagnosis Atrial Fibrillation - epidemiology Atrial Fibrillation - physiopathology Atrial Fibrillation - surgery cardiac magnetic resonance Catheter Ablation Continuous Positive Airway Pressure Female Heart Atria - pathology Heart Atria - physiopathology Heart Ventricles - pathology Heart Ventricles - physiopathology Humans Incidence Magnetic Resonance Imaging Male Middle Aged Original Research Prospective Studies Pulmonary Veins - physiopathology Pulmonary Veins - surgery Recurrence Risk Factors sleep apnea Sleep Apnea, Obstructive - diagnosis Sleep Apnea, Obstructive - epidemiology Sleep Apnea, Obstructive - physiopathology Sleep Apnea, Obstructive - therapy Time Factors Treatment Outcome Ventricular Remodeling Young Adult
Title	Effect of Sleep Apnea and Continuous Positive Airway Pressure on Cardiac Structure and Recurrence of Atrial Fibrillation
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