New evidence supports ablation in high-risk patients with atrial fibrillation and sleep apnea

New evidence supports ablation in high-risk patients with atrial fibrillation and sleep apnea

Obstructive sleep apnea and atrial fibrillation are two conditions that have a potentially fatal connection. One increases the likelihood of developing the other, and together, the breathing difficulties of sleep apnea combined with the irregular heartbeat of atrial fibrillation (AFib) can lead to life-threatening cardiovascular risks.

The standard treatment for atrial fibrillation is catheter ablation, a procedure in which doctors create scars in the heart to stop the electrical impulses that cause irregular heart rhythms.

But for decades, sleep apnea has been considered an obstacle to the success of ablation. Studies show that patients suffering from both conditions often have a higher incidence of atrial fibrillation and worse long-term outcomes.

Now, a new study from Tulane University suggests that ablation still offers major benefits for this high-risk group, significantly reducing the risk of heart failure and death for those diagnosed with sleep apnea and atrial fibrillation.

The study, published in theJournal of Cardiovascular Electrophysiologyfound that catheter ablation was associated with a 40% decrease in major cardiovascular events and a 70% decrease in all-cause mortality.

Catheter ablation was also associated with a lower risk of blood clots, which can block veins or arteries and cause an embolism or stroke.

“These results are encouraging for patients,” said lead author Dr. Ghassan Bidaoui, currently a resident at the Tulane University School of Medicine and a researcher at the Tulane Research Innovation Arrhythmia and Discovery Institute. "They suggest that catheter ablation can result in better long-term survival and fewer serious cardiac complications even when sleep apnea complicates atrial fibrillation treatment. This offers a path to personalized, comprehensive care in which procedural interventions are not dismissed solely because of comorbid sleep apnea but are considered as part of an integrated management strategy."

Using data from the global TriNetX network, researchers tracked the outcomes of more than 18,000 patients, half of whom received catheter ablation and half of whom did not. The study was one of the most comprehensive analyzes to date of the long-term benefits of catheter ablation in this high-risk population.

Co-author Dr. Nassir Marrouche, director of the Tulane University Heart and Vascular Institute, called the study “groundbreaking” for those living with both conditions.

By treating atrial fibrillation with catheter ablation, we have seen a dramatic reduction in risk; Reduction in mortality by over 70% and significant improvements in stroke, heart failure and coronary disease. These findings could redefine how we treat this high-risk group.”

Dr. Nassir Marrouche, Director, Tulane University Heart and Vascular Institute

It is estimated that more than 40 million people worldwide have been diagnosed with atrial fibrillation. It's harder to calculate how many people suffer from sleep apnea, but a recent study estimates that up to 1 billion people could be living with the condition.

As these numbers rise due to an aging population, Bidaoui and Marrouche hope that the results of this study can encourage earlier and more widespread use of catheter ablation to reduce cardiovascular stress and improve outcomes.

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