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Following cavotricuspid isthmus (CTI) ablation, many patients with atrial flutter (AFL) are diagnosed with atrial fibrillation (AF). The incidence, duration, pattern, and burden of AF remain undefined. These may have implications for the management of these patients.

Background:Patients (pts) with atrial fibrillation (AF) commonly suffer from obstructive sleep apnea (OSA). The Apnea + Hypopnea Index (AHI) is used to diagnose the severity of OSA. Patients with OSA are prescribed CPAP therapy.Objective:To determine the relationship between severity of OSA and compliance with CPAP therapy.Methods:The cohort included consecutive pts with AF and OSA prescribed CPAP. The severity of OSA was determined as follows: AHI <5 is normal; 5 ? AHI < 15 is mild OSA; 15 ? AHI < 30 is moderate OSA; 30 ? AHI is severe OSA. Compliance, typically defined as using CPAP for 4 or more hours 70% of the time in any given month, was also determined for 80%, 90% and 100% monthly compliance.Results:The cohort included 107 pts (65 ? 9 years; 74% male; 47% paroxysmal AF; BMI 34 ? 5). CPAP compliance (>70% monthly) was observed in only 58 (54%) pts. Compliance was significantly greater in pts with severe OSA as compared with mild-moderate OSA (57% vs. 43%, p=0.04, Figure). This relationship held true for all measures of monthly compliance (Figure). In pts with mild-moderate OSA, 100% compliance with CPAP was seen in only 9 (32 %) pts.Conclusion:In AF pts with documented OSA, monthly compliance with CPAP is poor. Pts with severe OSA tend to be more compliant than pts with mild-moderate OSA for all measures of monthly compliance. New strategies or OSA treatment tools need to be developed to effectively treat this condition in AF pts.

Background:A very late recurrence (VLR) of atrial fibrillation (AF) is considered present when a patient (pt) has their first recurrence of AF ? 12 months following ablation. However, the patterns of VLR AF recurrence have not yet been characterized.Objective:To assess the incidence and pattern of VLR in pts who underwent cryoballoon (CB) pulmonary vein isolation (PVI) alone.Methods:We enrolled consecutive pts with paroxysmal or persistent AF who underwent CB PVI and had a Reveal LINQ (Medtronic) implantable loop recorder (ILR) inserted < 3 months post-ablation. Pts free of AF 1-year post-ablation (excluding a 3-month post-ablation blanking period) were followed prospectively for recurrent AF. Four distinct patterns of recurrent AF were identified and characterized (Figure).Results:Our cohort included 70 pts (63 ? 11 years; 46 [66%] male; paroxysmal AF [n=40, 57%]; CHA2DS2-VASc 2.3 ? 1.7). They were followed for 839 ? 287 days (range: 371 to 1436 days), during which time 24 (34%) pts had VLR of AF. Twenty (83%) of these 24 patients had 1 of 3 distinct patterns of paroxysmal AF (Figure), with episodes lasting from 34 minutes to 54 hours. Only 4 (17%) pts developed persistent AF.Conclusions:Using ILRs for long-term ECG monitoring, we found that a third of pts develop VLR of AF post-CB PVI. For the first time, we demonstrate that in the vast majority of these pts, AF recurrences are paroxysmal and of short duration. Furthermore, ~50% of these pts have long AF-free periods. These data provide objective information about the efficacy of CB PVI in AF pts.