Predictors of Atrial Remodeling in Patients with Sleep Apnea: Analysis of Electrocardiographic and Echocardiographic Variables View PDF

^*Tamer El Andere
Department Of Cardiology, Instituto Dante Pazzanese De Cardiologia, Sao Paulo, Brazil

^*Corresponding Author:

Tamer El Andere
Department Of Cardiology, Instituto Dante Pazzanese De Cardiologia, Sao Paulo, Brazil
Email:drtamerelandere@gmail.com

Published on: 2021-12-08

Abstract

Background: Obstructive sleep apnea (OSA) is an important risk factor for the development and recurrence of atrial fibrillation (AF). Atrial remodeling (AR) plays a critical role in the genesis of AF. We evaluated electrocardiographic and echocardiographic variables (electrical, anatomic, and functional) associated with AR in patients with OSA.

Methods: Two hundred and three consecutive patients undergoing polysomnography were screened, by which 80 patients were included and divided into groups according to apnea-hypopnea index in OSA- (AHI < 15) or OSA+ (AHI ≥ 15). Minimum oxyhemoglobin saturation (>90%, 80-90%, and <80%) and total time <90% saturation [T90] (60 min) were correlated to electrocardiographic (12-lead and signal-averaged electrocardiogram - SAECG) and echocardiographic (2D strain and 3D volumetric and functional) variables.

Results: Patients with OSA+ presented lower left atrial passive emptying fraction (LAPEF) compared to OSA- patients. MinSat <80% was associated with increased P-wave duration on SAECG and lower conduit strain compared to those with MinSat >90%. T90 > 60min was associated with increased P-wave duration on SAECG and increased P-maximum, P-mean, and P-DII on 12-lead ECG, as well as shorter Tonset-Tpeak interval compared to 60min was associated with increased P-wave duration in DII and increased P/PRi interval compared to

Keywords

Sleep Apnea, Atrial Remodeling, Atrial Fibrillation, Hypoxia Echocardiography, Electrocardiography

Introduction

There has been increasing evidence on the impact of obstructive sleep apnea (OSA) on the onset, recurrence, and persistency of atrial fibrillation (AF) [1]. Atrial remodeling (AR) plays a critical role in this scenario [2].

Guidelines have been emphasizing the importance of the diagnosis of OSA in AF patients [3]. The presence of OSA is associated with lower arrhythmia-free survival rates compared to patients without OSA. Therefore, screening is an important step when rhythm-control strategy is chosen [4].

The pathophysiological interrelationship is established by the multifactorial atrial arrhythmogenesis presented in OSA patients. Recurrent hypoxemia, reoxygenation, and associated inflammation chronically activates autonomic, inflammatory and tissue remodeling responses [5].This promotes AR, which constitutes the arrhythmogenic substrate [6]. AR is divided into electrical [7], structural [8, 9], and functional AR [10].

The aim of the present study was to evaluate AR variables in patients with OSA using non-invasive electrocardiographic and echocardiographic methods, as well as the impact of the magnitude and duration of hypoxemia in these parameters.