Abstract 4144389: Obstructive Sleep Apnea is Associated with Ablation Failure in Paroxysmal Atrial Fibrillation Patients Only: Insights from a Left Atrial MRI Database

Background: Obstructive sleep apnea (OSA) may influence the outcomes of catheter ablation in atrial fibrillation (AF) patients, but its impact at different stages of AF is not well understood. Objective: This study aims to evaluate whether OSA influences catheter ablation outcomes differently in patients with paroxysmal AF compared to those with persistent AF. Methods: We included AF patients with and without obstructive sleep apnea (OSA) in a late gadolinium enhancement (LGE) MRI database of patients who underwent catheter ablation. Our study population was stratified based on the type of AF: paroxysmal or persistent. Patients were followed for 24 months post-ablation, with a 3-month blanking period. To analyze time-to-AF recurrence, we used Kaplan-Meier curve along with the log-rank test to compare recurrence rates between patients with and without OSA in both AF types. Additionally, we used Cox regression analysis to adjust for potential confounders. Results: 324 patients with paroxysmal AF (mean age: 64.5) and 512 patients with persistent AF (mean age: 65.2) were included. The left atrial (LA) volume was similar between OSA and non-OSA patients in both the paroxysmal AF cohort (83.1 mm3 vs. 83.6 mm3; p=0.73) and the persistent AF cohort (115 mm3 vs. 119 mm3; p=0.37). Patients with OSA exhibited a higher prevalence of comorbidities, including congestive heart failure (CHF), coronary artery disease, obesity, and diabetes, compared to non-OSA patients (p<0.05). After adjusting for these comorbidities, OSA was significantly associated with a higher rate of AF recurrence following ablation in paroxysmal AF patients (HR=2.249; p<0.001). However, OSA did not significantly impact ablation outcomes in persistent AF patients (HR=1.014; p=0.836). Conclusion: OSA significantly impacts the success of catheter ablation in patients with paroxysmal atrial fibrillation (AF), leading to higher rates of AF recurrence. However, this association was not observed in patients with persistent AF.