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. 2025 Oct 21.
doi: 10.1111/jce.70152. Online ahead of print.

Catheter Ablation Is Associated With a Decrease in Major Adverse Cardiovascular Events and All-Cause Mortality in Patients With Atrial Fibrillation and Obstructive Sleep Apnea

Ghassan Bidaoui  1 , Christian Massad  1 , Joe Abi-Rached  1 , Ahmed Abdelmaksoud  1 , Eman Toraih  1 , Michel Abou-Khalil  1 , Mayana Bsoul  1 , Montaser Atasi  1 , Amitabh Pandey  1 , Nassir Marrouche  1 ; and other members of the TRIAD Team  1 ; Yara Menassa  1 , Han Feng  1 , Swati Rao  1 , Chanho Lim  1 , Ala' Assaf  1 , Hadi Younes  1
Affiliations

Catheter Ablation Is Associated With a Decrease in Major Adverse Cardiovascular Events and All-Cause Mortality in Patients With Atrial Fibrillation and Obstructive Sleep Apnea

Ghassan Bidaoui et al. J Cardiovasc Electrophysiol. .

Abstract

Introduction: Obstructive sleep apnea (OSA) is a common risk factor for the development and progression of atrial fibrillation (AF). Whether catheter ablation for AF management in patients with coexisting OSA yields survival benefit remains unclear. This study aimed to assess the association of catheter ablation with the incidence of major cardiovascular events (MACE) and all-cause mortality in patients with AF and OSA.

Methods: This was a retrospective cohort study using the TriNetX electronic health record (EHR) database, a global, federated clinical research network aggregating de-identified patient data from multiple healthcare organizations. The study was conducted using real-world data collected from community-based healthcare institutions contributing to the TriNetX network. This multicenter, population-based dataset includes both primary care and referral center data from across the United States and internationally. Adult patients diagnosed with both AF and OSA between November 2014 and November 2024 were included. Patients entered the study at the time of AF diagnosis, with follow-up beginning 3 months later. A total of 18,324 patients were included after 1:1 propensity score matching, 9162 who underwent catheter ablation and 9162 who did not. Matching was performed based on over 30 clinical and demographic variables, including age, sex, body mass index, comorbidities, medications (e.g., anticoagulation), CPAP prescription, echocardiographic data, and laboratory values. Participants were selected using a convenience sampling method from those available in the database, with inclusion contingent on complete data and fulfillment of eligibility criteria. Data on refusals or exclusions were not available due to the nature of de-identified secondary EHR data.

Results: Over a median follow-up of 807 days, 687 MACE events and 438 all-cause mortality events were recorded. Catheter ablation was associated with a significantly reduced risk of MACE (HR: 0.596, 95% CI: 0.510-0.697) and all-cause mortality (HR: 0.264, 95% CI: 0.208-0.335). It was also associated with reduced risk of specific cardiovascular outcomes, including heart failure (HR: 0.376, 95% CI: 0.283-0.501), cerebrovascular disease (HR: 0.492, 95% CI: 0.348-0.696), and cerebral infarction (HR: 0.390, 95% CI: 0.207-0.733).

Conclusion: Catheter ablation in patients with AF and OSA is associated with a reduced risk of MACE, all-cause mortality, heart failure, and thromboembolic events.

Keywords: all‐cause mortality; atrial fibrillation; catheter ablation; major cardiovascular events; obstructive sleep apnea.

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