Origin of Premature Atrial Beats Induced by Simulated Obstructive Sleep Apnea

University of Zurich2 enrolled

Overview

There is accumulating evidence for obstructive sleep apnea (OSA) as an independent risk factor for paroxysmal atrial fibrillation and for high recurrence rates of atrial fibrillation after ablation therapy. We have previously shown that simulated OSA triggers premature atrial beats (PABs) by acute changes in intra-thoracic pressure. Most episodes of atrial fibrillation are initiated by PABs. However, the origin of PABs induced by intra-thoracic pressure swings is unknown. This study investigates the origin of premature atrial beats induced by intra-thoracic pressure changes that simulate obstructive sleep apnea in patients with atrial fibrillation.

Study Type

INTERVENTIONAL

Allocation

NON_RANDOMIZED

Purpose

BASIC_SCIENCE

Masking

NONE

Enrollment

Conditions

Atrial Fibrillation Sleep Apnea, Obstructive Atrial Premature Complexes

Interventions

Standard pulmonary vein isolationPROCEDURE

The MM will be carried out during a elective standard pulmonary vein isolation procedure. The MM will be performed using an occluded mouthpiece with a small air leak to prevent complete closure of the glottis during inspiration and thus assure negative pressure throughout the entire airway. After expiration, inspiration with a target negative intrathoracic pressure of -40mmHg will be carried out against the mouthpiece.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 75 Years

Medical Language ↔ Plain English

Inclusion Criteria: * History of ECG-documented paroxysmal atrial fibrillation within the last 12 months and currently in sinus rhythm * Scheduled for circumferential pulmonary venous isolation treatment * 18 to 75 years of age * Signed informed consent Exclusion Criteria: * Treated with class III anti-arrhythmic agents (at the moment of pulmonary venous isolation) * Treated for obstructive sleep apnea * Previous catheter ablation in the pulmonary veins or left atrium * Severe structural heart disease * Mental or physical disability precluding informed consent or compliance with the protocol * Enrolled in another study that would confound the results of this trial

Outcomes

Primary Outcomes

Electroanatomical origin of premature atrial beats

(Loop-)Catheter-based origin detection in patients with apnea-hypopnea index \> 5/h in home sleep study and documented premature atrial beats during three time points: baseline (normal breathing), inspiration through a threshold load device, and the Mueller Manoeuvre (MM). Origins will be quantitatively marked at a left atrial map.

Time frame: Participants will be followed for the duration of pulmonary vein isolation, an expected average of 3 hours

Secondary Outcomes

Catheter-based pressure in the left atrium and pulmonary veins during intra-thoracic pressure changes

Catheter-based left atrial pressure measurement in patients with apnea-hypopnea index \> 5/h in home sleep study and documented premature atrial beats during three time points: baseline (normal breathing), inspiration through a threshold load device, and the Mueller Manoeuvre. Changes in left atrial pressure will be recorded in cmH2O.