Highlights
- •Pacemaker-diagnosed sleep apnea is associated with higher atrial fibrillation risk.
- •Indices of sympathovagal imbalance further stratify patients for atrial fibrillation risk.
- •These markers may provide an early warning for atrial fibrillation risk.
- •These markers may allow to tailor effective treatment to mitigate risk.
Abstract
Aims
Sleep apnea (SA) is a risk factor for atrial fibrillation (AF) occurrence. Sympathovagal
imbalance is a mechanism that predisposes to the development of AF and that occurs
in SA. Some pacemakers can detect SA events and continuously measure a time domain
measure of heart rate variability (HRV), i.e. the standard deviation of 5-min median
atrial–atrial sensed intervals (SDANN). We evaluated the association between the occurrence
of AF and device-detected SA and SDANN in patients who received pacemakers.
Methods
We enrolled 150 consecutive patients undergoing implantation of a dual-chamber pacemaker,
capable of SA and SDANN estimation. The SA was defined as severe if the Respiratory
Disturbance Index was ≥30 episodes/h for at least one night during the first week
after implantation.
Results
Sixteen patients in permanent AF were excluded from our analysis. During follow-up,
AF (cumulative device-detected AF duration > 6 h/day) occurred in 24(18%) patients
out of the remaining 134 patients. Severe SA was detected in 84 patients. SDANN values
were available in 74 patients and the median value was 76 ms [25°–75°percentile:58–77].
The risk of AF was higher in patients with severe SA (log-rank test; p = .033). The
presence of either or both conditions (severe SA and SDANN < 76 ms) was associated
with shorter time to AF event (p = .042) and was an independent predictor of AF (hazard
ratio: 2.37; 95%CI:1.08 to 5.21; p = .033).
Conclusion
In pacemaker patients, device-diagnosed severe SA and reduced SDANN are associated
with a higher risk of AF.
Keywords
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Article info
Publication history
Published online: July 26, 2019
Accepted:
July 21,
2019
Received in revised form:
July 19,
2019
Received:
February 1,
2019
Identification
Copyright
© 2019 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
