The following is a summary of “Obstructive Sleep Apnea as a Predictor of Inducible Atrial Flutter During Pulmonary Vein Isolation in Patients With Atrial Fibrillation: Clinical Significance and Follow-Up Outcomes,” published in the July 2023 issue of Cardiology by Taylor et al.
For a study, researchers sought to explore the potential role of obstructive sleep apnea (OSA) predictor of inducible atrial flutter (AFL) during pulmonary vein isolation in Atrial fibrillation (AF) patients and reexamine inducible AFL’s clinical significance regarding recurrent AF or AFL during follow-up. The coexistence of AF and AFL can lead to severe complications, and prophylactic cavotricuspid isthmus (CTI) ablation wasn’t successful in lessening the occurrence of recurrent AF and new cases of AFL.
A single-center retrospective study enrolled 192 patients who underwent PVI procedures between October 2013 and December 2020 after screening 257 patients with specific criteria. All patients were examined to omit a left atrial appendage thrombus through a transesophageal echocardiogram (TEE) before ablation. PVI used fluoroscopic and electroanatomic mapping emanated from intracardiac echocardiography. Additional electrophysiology (EP) testing was performed after PVI confirmation. Then, AFL categorized either typical or atypical based on their origin and pattern. Chi-square, Fisher’s exact tests, and Logistic regression analysis were used to compare independent groups on categorical results and to adjust for confounding variables.
After PVI, 52% (n = 100) showed inducible AFL, and 43% (n = 82) indicated typical right AFL. The examination of any inducible AFL result through bivariate analysis demonstrated significant differences between cohorts for OSA (P = 0.04) and persistent AF (P = 0.047). When examining the typical right AFL outcome, OSA (P = 0.04) and persistent AF (P = 0.043) were significant when examining the typical right AFL outcome. After Multivariate analysis, they discovered that only OSA had a substantial relation with the possibility of having any AFL after considering other variables (adjusted odds ratio (AOR) = 1.92, 95% CI: 1.003 – 3.69, P = 0.049). About 89 out of 100 with inducible AFL received additional treatment for ablation before completing the main procedure. At one year, the recurrence for AF, AFL, and either AF or AFL were 31%, 10%, and 38%. There was no considerable difference in the AF, AFL, or both AF/AFL recurrence rates regardless of inducible AFL presence or additional AFL ablation effectiveness.
The study demonstrated a high occurrence of inducible AFL during PVI, especially in patients with OSA. However, the clinical significance of this finding regarding AF or AFL recurrence after one year remained uncertain.
Source: cardiologyres.org/index.php/Cardiologyres/article/view/1491/1449