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Severe sleep apnea associated with higher risk for AF in patients with pacemakers

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SAN FRANCISCO — In patients with pacemakers, severe sleep apnea was a significant predictor of atrial fibrillation, according to a study presented at the Heart Rhythm Society Annual Scientific Sessions.

Although sleep apnea is a known risk factor for AF, there were little data on the association between sleep apnea and AF in patients with pacemakers, according to the study background.

Researchers analyzed 150 patients with atrioventricular block or sick sinus syndrome who were implanted with a dual-chamber pacemaker. In the first week after implantation, patients were monitored for sleep apnea using an algorithm (ApneaScan, Boston Scientific).

“In recent years, pacemakers have increasingly become equipped with sleep apnea monitoring measures, and in using these tools, we were able to identify how pacemaker patients with sleep apnea are at risk for developing [AF],”Andrea Mazza, MD, of the Santa Maria della Stella Hospital, Umbria, Italy, said in a press release.

Severe sleep apnea was defined as at least 30 sleep apnea events per hour in one night. AF episodes were defined as detection of arrhythmia for more than 1 hour.

At 8 months, AF occurred in 36% of patients, including in 28% of the 89 patients with no history of AF. In patients with severe sleep apnea, the risk for AF was threefold higher (HR = 3.09; 95% CI, 1.64-5.81). Patients with severe sleep apnea and no history of AF had a nearly sixfold increased risk for AF (HR = 5.8; 95% CI, 2.22-15.12), according to the researchers.

“Often, we are used to treating our patients by means of antiarrhythmic drugs when they are affected by [AF], but in many cases, our therapeutic approach could be different, because sleep apnea is the basis of the arrhythmia,” Mazza said in an interview with Cardiology Today. “The next step, in my opinion, is try to assess a correlation between pacemaker-detected sleep apnea and the incidence of thrombotic events in these patients, but of course to assess this correlation requires a much larger number of patients.” – by Dave Quaile

Reference:

Mazza A, et al. Session PO01. Presented at: Heart Rhythm Society Scientific Sessions; May 4-7, 2016; San Francisco.

Disclosure: Mazza reports no relevant financial disclosures.