New study shows patients with pacemakers and sleep apnea are at increased risk of atrial fibrillation

Results from a first-of-its-kind study identify a significant increase in the incidence of atrial fibrillation (AF) among patients with pacemaker-detected sleep apnea. The study, presented at Heart Rhythm 2016, the Heart Rhythm Society's 37th Annual Scientific Sessions, suggests that monitoring for sleep apnea in patients with pacemakers is imperative in identifying patients' risk for developing AF.

Sleep apnea is a common condition in which breathing stops or becomes critically shallow during sleep. It is associated with cardiovascular diseases and is highly prevalent in patients with pacemakers.¹ While it is understood that sleep apnea is a risk factor for AF, the risk of AF for pacemaker patients with sleep apnea is largely unknown.

The study enrolled a total of 150 patients with atrio-ventricular block or sick sinus syndrome who underwent implantation of a dual-chamber pacemaker. The patients were monitored for sleep apnea events during the first week after the device was implanted. The severity of sleep apnea in patients was determined by the pacemakers' ApneaScan algorithm (Boston Scientific), which automatically detects sleep apnea events. Sleep apnea was defined as severe if a patient had 30 or more events per hour for at least one night. If the device detected arrhythmias for more than one hour in a day, patients were considered to have experienced AF episodes.

During an 8-month follow-up, AF occurred in 36 percent of patients and, specifically, in 25 (28 percent) out of the 89 patients who had no history of the arrhythmia. Severe sleep apnea was detected in 85 patients, 56 of whom had no history of AF. In presence of severe sleep apnea, the risk of AF was 3-fold higher in the overall population, and approximately 6-fold higher among those with no previous history of AF.

"In recent years, pacemakers have increasingly become equipped with sleep apnea monitoring measures, and in using these tools, we were able to identify how pacemaker patients with sleep apnea are at risk for developing atrial fibrillation," said Andrea Mazza, MD, Santa Maria della Stella Hospital. "Our results are the first to show that patients with pacemakers and sleep apnea are at a higher risk of developing atrial fibrillation. Now that we understand the connection, it's important that patients and doctors, collectively, are more diligent about monitoring for sleep apnea in order to engage in solutions that may prevent the development of atrial fibrillation and, possibly, thromboembolic complications."

Study authors note that a high prevalence of sleep apnea in patients with pacemakers requires a more defined approach to diagnosis in order to explore potential therapeutic targets for reducing occurrence and recurrence of AF.