Impact of Obstructive Sleep Apnea on Arrhythmia and Quality-of-Life Outcomes After Catheter Ablation of Atrial Fibrillation.

BACKGROUND: Catheter ablation is a first-line therapy for atrial fibrillation (AF). We evaluated the impact of obstructive sleep apnea (OSA) on arrhythmia and postablation quality-of-life outcomes among AF subtypes. METHODS: Consecutive patients undergoing AF ablation (2013-2022) at a tertiary center were enrolled and assessed for arrhythmia recurrence over 3-year follow-up. A subset of patients enrolled in an automated patient-reported outcomes platform were assessed for quality of life, including Atrial Fibrillation Severity Score and AF burden (AF duration and frequency scores). RESULTS: A total of 7020 patients were included: 3380 with paroxysmal AF (PAF) and 3640 with persistent AF (PersAF), of whom 729 and 943 had OSA, respectively (PAF: age, 66.5±10 years [69% men]; PersAF: age, 66.1±9 years [76% men]). Unlike patients with PersAF, those with PAF and OSA had higher AF recurrence (PAF: no OSA=70% versus OSA=64% [P<0.01]; PersAF: no OSA=57% versus OSA=60% [P=0.24]). Baseline OSA was independently associated with a 30% increased AF recurrence risk (hazard ratio, 1.30; P<0.001) among patients with PAF, but not among patients with PersAF. Significant improvement in 1-year postablation quality of life was noted in both groups irrespective of OSA (P<0.001 for all comparisons): (1) median AF symptom severity (PAF: no OSA 10→2, OSA 12→4; PersAF: 12→4 in both groups); and (2) median AF duration (PAF: 6.25→0 in both groups; PersAF: 10→0 in both groups); median AF frequency (PAF: 6→0 in both groups; PersAF: 9→0 in both groups). CONCLUSIONS: Baseline OSA was associated with an increased AF recurrence risk in patients with PAF, but not in those with PersAF. Catheter ablation resulted in improvement of quality-of-life metrics irrespective of baseline OSA among AF subtypes.