EXTENDED CARDIAC MONITORING IN PATIENTS WITH SEVERE SLEEP APNEA AND NO HISTORY OF ATRIAL FIBRILLATION (THE REVEAL XT-SA STUDY)

Abstract Background New generation pacemaker allow the assessment day by day of sleep disordered breathing (SDB) based on impedance measurement. A recent study demonstrated that incidence of AF is higher in case of severe SA monitored by pacemaker Purpose The aim was to compare the atrial fibrillation (AF) burden between patients with severe and non-severe sleep apnea (SA) detected with pacemakers monitoring (SDB). Methods This retrospective study was carried out at our University Hospital. We included all patients with Microport CRM pacemaker implanted from 2013 to 2016 at our university hospital. Exclusion criteria were inactivation of sleep apnea monitoring (SAM), history of sleep apnea, missing data or invalid data. AF burden was assessed according to Fallback mode switch (FMS) duration. Respiratory disturbance index (RDI) was calculated as the average number of events (ventilation pause and reductions) per number of hours of monitoring. Patients with RDI<20/h were compared with patients with RDI≥20/h (considered as severe SA group). Results 404 patients (mean age = 79.7±10 years; 52.0% men) were included. The most prevalent indication for cardiac pacing was atrioventricular block in 57%. Mean RDI was 18.9 events per hour. 234 (58%) of them had a mean RDI <20 and 170 (42%) had a mean RDI ≥20. Compared to patients with mean RDI<20, those with mean RDI ≥20 were youngers (78.6±10 years Vs 81.8±8 years; p=0.02), were more likely to be male (58.2% Vs 47.5%: p=0.035) and had more heart failure history (28.8% Vs 19.2%: p=0.03). BMI was not different between groups (26.3±5. vs 26.3±4; P=0.33). Mean follow-up was 27 months. Patients with RDI ≥20 had a mean Atrial fibrillation duration longer than patients with RDI <20 (631 min Vs 291 min respectively; p=0.014). RDI was correlated with FMS (r=0.26; p=0.0004). The stroke rate tended to be higher in the RDI ≥20 group (2.1% vs 5.4%) (p=0.12). Conclusion Severe SA detected by pacemaker was associated with longer AF duration. We did not find higher occurrence of stroke in the severe SA group. Funding Acknowledgement Type of funding source: None

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Short Term Cardiac Monitoring of Patients with Severe Sleep Apnea does not Allow for the Prediction of Atrial Fibrillation

Journal of Electrocardiology ◽

10.1016/j.jelectrocard.2019.01.024 ◽

2019 ◽

Vol 53 ◽

pp. e6-e7

Author(s):

Cynthia Yeung ◽

Doran Drew ◽

Sharlene Hammond ◽

Gwen Ewart ◽

Laiden Suarez-Fuster ◽

...

Keyword(s):

Atrial Fibrillation ◽

Sleep Apnea ◽

Cardiac Monitoring ◽

Short Term ◽

Severe Sleep Apnea

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Subclinical Atrial Fibrillation and Risk of Stroke: Past, Present and Future

Medicina ◽

10.3390/medicina55100611 ◽

2019 ◽

Vol 55 (10) ◽

pp. 611 ◽

Cited By ~ 3

Author(s):

AlTurki ◽

Marafi ◽

Russo ◽

Proietti ◽

Essebag

Keyword(s):

Atrial Fibrillation ◽

Clinical Practice ◽

Electronic Devices ◽

High Rate ◽

Cardiac Monitoring ◽

Stroke Event ◽

Cardiac Implantable Electronic Devices ◽

Increased Risk ◽

History Of ◽

New Evidence

Subclinical atrial fibrillation (SCAF) describes asymptomatic episodes of atrial fibrillation (AF) that are detected by cardiac implantable electronic devices (CIED). The increased utilization of CIEDs renders our understanding of SCAF important to clinical practice. Furthermore, 20% of AF present initially as a stroke event and prolonged cardiac monitoring of stroke patients is likely to uncover a significant prevalence of SCAF. New evidence has shown that implanting cardiac monitors into patients with no history of atrial fibrillation but with risk factors for stroke will yield an incidence of SCAF approaching 30–40% at around three years. Atrial high rate episodes lasting longer than five minutes are likely to represent SCAF. SCAF has been associated with an increased risk of stroke that is particularly significant when episodes of SCAF are greater than 23 hours in duration. Longer episodes of SCAF are incrementally more likely to progress to episodes of SCAF >23 hours as time progresses. While only around 30–40% of SCAF events are temporally related to stroke events, the presence of SCAF likely represents an important risk marker for stroke. Ongoing trials of anticoagulation in patients with SCAF durations less than 24 hours will inform clinical practice and are highly anticipated. Further studies are needed to clarify the association between SCAF and clinical outcomes as well as the factors that modify this association.

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Pacemaker-detected severe sleep apnea predicts new-onset atrial fibrillation

EP Europace ◽

10.1093/europace/euw371 ◽

2017 ◽

Vol 19 (12) ◽

pp. 1937-1943 ◽

Cited By ~ 17

Author(s):

Andrea Mazza ◽

Maria Grazia Bendini ◽

Raffaele De Cristofaro ◽

Mariolina Lovecchio ◽

Sergio Valsecchi ◽

...

Keyword(s):

Atrial Fibrillation ◽

Sleep Apnea ◽

Onset Atrial Fibrillation ◽

Severe Sleep Apnea ◽

New Onset

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Abstract 17143: Obstructive and Central Sleep Apnea and Risk of Incident Atrial Fibrillation

Circulation ◽

10.1161/circ.130.suppl_2.17143 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Patricia Tung ◽

Yamini S Levitzky ◽

Rui Wang ◽

Stuart F Quan ◽

Daniel J Gottlieb ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Sleep Apnea ◽

Central Sleep Apnea ◽

Health Study ◽

Apnea Hypopnea Index ◽

Community Based ◽

Obstructive Sleep ◽

History Of

INTRODUCTION: Prior studies have documented a higher prevalence of atrial fibrillation (AF) in those with obstructive sleep apnea (OSA). OSA has been associated with AF recurrence following cardioversion and ablation, and with prevalent and incident AF in cross-sectional and retrospective studies. Central sleep apnea (CSA) also has been associated with AF in patients with heart failure. However, data from prospective cohorts are sparse and few studies have evaluated the association of CSA with AF in population studies. METHODS: We assessed the association of OSA and CSA with incident AF among 3,420 subjects without a history of AF in the Sleep Heart Health Study (SHHS), a prospective, community-based study designed to evaluate the cardiovascular consequences of sleep disordered breathing. Subjects underwent overnight polysomnography at baseline and were followed over time for the development of incident AF, documented at any time after baseline polysomnogram until the end of follow-up. OSA was defined as an obstructive apnea-hypopnea index ≥ 5 and CSA was defined as a central apnea index ≥ 5. RESULTS: At baseline, the sample include 1499 men (44.4%) with a mean age of 62.4 (±10.9); 1569 (45.9%) subjects met criteria for mild to severe OSA and 54 (1.6%) for CSA. Over a mean follow-up of 8.2 years, 382 cases of incident AF were identified. The prevalence of both OSA and CSA was higher among those who developed AF compared to those who did not (OSA 49% vs 44%, p=0.001 and CSA 5% vs 1.2%, p=0.001). After adjustment for multiple AF risk factors, CSA was associated with an approximately 2-fold increased odds of incident AF (RR=2.38, 95% CI, 1.15-4.94; p = 0.02). The association persisted after exclusion of 258 subjects with a history of heart failure (RR=2.78, 95% CI, 1.28-6.04; p = 0.01). We did not find a significant association of OSA with incident AF (Table). CONCLUSION: In our prospective, community-based cohort baseline CSA was associated with incident AF.

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