Prediction of Underling Sinus Node Dysfunction during Chronic Atrial Fibrillation before Catheter Ablation Using Apnea/Hypopnea Index

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Background: Indication of ablation has been expanded to include chronic atrial fibrillation (CAF) for enabling high degree of sinus rhythm maintenance. We have encountered patients undergoing pacemaker implantation, in whom sick sinus syndrome became clinically evident after ablation. The study aims to investigate whether underling sinus node dysfunction (SND) during CAF can be predicted before deciding the indication for ablation. Methods and Results: Sixty consecutive patients with CAF who underwent ablation between January to December 2010 were enrolled in the study. Nocturnal polysomnography as well as echocardiography was performed for all patients before ablation. We used the double Lasso catheter and electro anatomical mapping guided extensive encircling pulmonary vein isolation (EEPVI). We performed electrophysiological studies after EEPVI, and SND was defined as corrected SN recovery time of ≥550 ms. SND was detected in 26 (43%) patients (SND group); the other patients showed normal sinus node function (NSN group). The apnea/hypopnea index (AHI) was significantly greater in the SND group than in the NSN group (25.7±13 vs 15.8±10, P=0.0022). On multivariate analysis, sleep apnea syndrome (SAS) was an independent predictor of SND after ablation for CAF. Conclusion: This study suggested that underlying SND in CAF patients can be predicted by evaluating SAS before ablation.