Introduction: Sleep instability is highly prevalent in patients with cardiovascular disease (CVD) and evidence supports a causal association of sleep instability with CVD. We investigate the impact of radio-frequency catheter ablation (RFCA) on sleep instability in patients with paroxysmal atrial fibrillation (pAF) and the effect of sleep stability on recurrence of AF.
Methods: This retrospective observational study was performed in pAF patients who underwent RFCA between October 2007 and January 2017. Of the total 445 patients, 24-hr Holter study was performed in 218 patients before and 6 months after RFCA. Sleep stability was assessed by 24-hr Holter study using cardiopulmonary coupling (CPC) analysis. We compared CPC parameter (high-frequency coupling[HFC], low-frequency coupling[LFC], very low-frequency coupling[VLFC], narrow-band, broad-band) before and after RFCA.
Results: Sleep stability was significantly improved six-month after RFCA. HFC (marker of stable sleep) and VLFC (REM/wakefulness marker) was increased (29.84% to 36.15%, p<0.001, 26.20% to 28.76%, p=0.002, respectively) while LFC, unstable sleep marker, was decreased (41.25% to 32.13%, p<0.001) after RFCA. In the patients with pre-RFCA LFC<50.3%, the recurrence rate was higher than patients with pre-RFCA LFC≥50.3%. After adjusting for baseline characteristics (including age, CHA2DS2-VASC score, LAVI, creatinine, etc.), pre-RFCA LFC<50.3% remained a significant predictor of recurrence of AF (HR 8.24 (1.88-36.06), p=0.005) during 46.4 months of median follow-up.
Conclusions: Sleep quality was improved after RFCA in patients with pAF. Furthermore, the recurrence rate was significantly lower after RFCA in patient who had pre-RFCA sleep instability(LFC≥50.3%). These results suggest that RFCA can influence sleep quality and sleep quality assessment by analyzing routine 24-hr Holter study can be a predictable marker of recurrence after RFCA in patients with pAF.