Effect of CPAP therapy on left atrial remodeling in patients with paroxysmal atrial fibrillation and obstructive sleep apnea undergoing pulmonary vein isolation

Aim. To study the isolated effect of obstructive sleep apnea (OSA) on left atrial (LA) remodeling in patients with paroxysmal atrial fibrillation (AF) who underwent pulmonary vein (PV) ablation and concomitant severe and moderate OSA.

Material and methods. A subanalysis of echocardiographic data was performed in 50 patients with paroxysmal AF and moderate/severe OSA who underwent PV isolation and were followed up for 12 months (main group, 33; control group, 17). The clinical efficacy of catheter ablation was assessed after the end of the threemonth blind period. The following echocardiographic parameters were included in the subanalysis: anterior-posterior LA dimension, LA volume, LA volume index (LAVI), and pulmonary artery systolic pressure (PASP).

Results. After 12 months, the control group showed a significant increase in the anterior-posterior LA dimension (40,5 (40-42) mm vs 42 (40-45) mm, p=0,037), LA volume (68,5 (58-74,5) ml vs 69 (63-89) ml, p=0,006), LAVI (35,0 (29-37) ml/m² vs 35,5 (32-41,5) ml/m², p=0,005) and PASP (27 (25-30) vs 30 (29-33), p=0,004). Intragroup analysis of patients not receiving continuous positive airway pressure (CPAP) therapy and without recurrent AF did not reveal significant changes in LA size (anterior-posterior LA dimension — 40 (40-42) mm vs 40 (40- 41) mm, p=0,317; LA volume — 63 (58-71) ml vs 64 (61-69) ml, p=0,509; LAVI — 32 (29-36) ml/m² vs 33 (31-34) ml², p=0,509).

Conclusion. In patients with paroxysmal AF and concomitant moderate to severe OSA who underwent AF catheter treatment, the absence of CPAP therapy is not associated with a significant increase in the linear and volume LA dimensions in the absence of AF recurrence.

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