Sleep duration and the risk of recurrent arrhythmias after catheter ablation of atrial fibrillation: the PREDIMAR study
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Background
Short and long sleep duration have been linked to atrial fibrillation (AF), but their influence on arrhythmia recurrence after catheter ablation is uncertain. We evaluated the association between nocturnal sleep duration and the risk of recurrent arrhythmias in patients undergoing catheter ablation for AF in the PREDIMAR trial.
Methods
The PREDIMAR study is a multicentre, randomized, controlled, single-blind trial evaluating a Mediterranean diet enriched with extra-virgin olive oil for preventing arrhythmia recurrence after catheter ablation for AF. Nocturnal sleep duration was categorized as adequate (6–8 h/day) or inadequate (<6 h/day or >8 h/day). Multivariable Cox regression models estimated the association between sleep duration and the risk of recurrent atrial flutter (AFL) or AF.
Results
Among 720 participants, we observed 226 incident cases of AF relapse and 107 cases of AFL. Inadequate nocturnal sleep duration was associated with a significantly higher risk of AFL recurrence compared with adequate sleep (adjusted HR = 1.87; 95% CI 1.18–2.96). No significant association was observed for AF recurrence (HR = 0.99; 95% CI 0.70–1.41). The association with AFL recurrence was particularly evident in patients with persistent AF at baseline before ablation (adjusted HR = 3.42; 95% CI 1.47–7.97), whereas no significant relationship was observed in those with baseline paroxysmal AF.
Conclusions
Inadequate nocturnal sleep duration (<6 h/day or >8 h/day) may increase the risk of AFL recurrence following AF ablation. These findings highlight the relevance of sleep habits as a modifiable behavioural factor potentially influencing post-ablation outcomes.
Registration
https://www.clinicaltrials.gov ; Unique Identifier: NCT03053843 .
Clinical Perspective
What Is New?
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In patients undergoing catheter ablation for atrial fibrillation, inadequate nocturnal sleep duration (<6 or >8 h/day) was independently associated with a nearly two-fold higher risk of atrial flutter recurrence, with no significant association for atrial fibrillation recurrence.
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The association with atrial flutter recurrence was especially pronounced among patients with persistent atrial fibrillation before ablation.
What Are the Clinical Implications?
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Assessing and optimizing sleep duration may represent a modifiable behavioural target to improve arrhythmia-free outcomes after atrial fibrillation ablation, particularly in patients with persistent atrial fibrillation.
