Catheter ablation shows benefits for patients with both aFib and sleep apnea

People who have both atrial fibrillation (AFib) and obstructive sleep apnea (OSA) often face elevated risks of heart failure, stroke and death. For decades, sleep apnea has been viewed as a complicating factor that undermines the benefits of catheter ablation, the standard procedure to correct atrial fibrillation.

A new study published this October in the Journal of Cardiovascular Electrophysiology challenges that assumption, showing that catheter ablation is associated with significantly reduced risk of major cardiovascular events and mortality even in patients with obstructive sleep apnea.

Researchers have come to understand that there is a strong association between obstructive sleep apnea and atrial fibrillation, a heart rhythm disorder that can also raise the risk of stroke and heart failure. The disorders are linked, with obstructive sleep apnea leading to physiological changes that predispose people to arrhythmia. Catheter ablation uses energy to create little scars in the heart, which can help to restore cardiac rhythm.

The findings from the new study revealed ablation cuts cardiovascular risk in atrial fibrillation patients with sleep apnea. Researchers, led by Ghassan Bidaoui, M.D., of the Tulane Research Innovation for Arrhythmia Discovery Institute at Tulane University in New Orleans, utilized a large retrospective cohort drawn from the global TriNetX electronic-health record network.

Overall, they identified 18,324 adults diagnosed with both atrial fibrillation and obstructive sleep apnea for a 10-year period, with 9,162 having undergone catheter ablation and 9,162 patients who did not receive catheter ablation. They conducted propensity-score matching for more than 30 clinical and demographic variables, including age, sex, body mass index, comorbidities, use of anticoagulation, continuous positive airway pressure prescriptions and echocardiographic data.

Over a median follow-up of 807 days, the data revealed major reductions in risk among ablation patients. Compared with those managed without ablation, the ablation group had a nearly 40% lower risk of major adverse cardiovascular events and a roughly 70% lower risk of all-cause mortality.

Additionally, catheter ablation was associated with significantly reduced rates of heart failure hospitalizations and vascular events, including stroke or embolism.

“These findings are encouraging,” Bidaoui said in a Tulane news release. “They suggest that even when sleep apnea complicates AFib management, catheter ablation can still lead to better long-term survival and fewer serious cardiac complications. This offers a pathway toward personalized, comprehensive care where procedural interventions are not dismissed solely based on comorbid sleep apnea but rather considered as part of an integrated management strategy.”

Nassir Marrouche, M.D., director of the Tulane University Heart and Vascular Institute and a co-author, called the results a game-changer for patients who live with both atrial fibrillation and obstructive sleep apnea. He noted that treating atrial fibrillation with catheter ablation, together with standard sleep apnea management and anticoagulation, appeared to dramatically lower the risk of death and serious cardiovascular outcomes.

The study’s findings have important implications for clinical practice. Historically, clinicians have been reluctant to recommend ablation to patients with obstructive sleep apnea because of concern that recurrent arrhythmia, ongoing airway obstruction or other sleep-related complications would negate benefit.

However, this new data argues that ablation should not be automatically ruled out and patients with atrial fibrillation and obstructive sleep apnea could benefit from a comprehensive strategy combining rhythm control, sleep-disorder therapy and close cardiovascular follow-up.

The researchers noted this strategy may improve long-term outcomes, reduce hospitalizations and support better quality of life.

The study authors caution that their analysis is observational and cannot prove causation, explaining that factors such as adherence to continuous positive airway pressure therapy, lifestyle differences and variations in anticoagulation or medication regimens may have influenced outcomes. The research team called for prospective randomized trials to confirm whether the survival benefit holds when such variables are controlled.