Central sleep apnea and atrial fibrillation: A review on pathophysiological mechanisms and therapeutic implications

• Main Authors: Alexandra M. Sanchez, Robin Germany, Matthew R. Lozier, Michael D. Schweitzer, Semaan Kosseifi, Rishi Anand
• Format: Article
• Language: English
• Published: Elsevier 2020-10-01
• Series: International Journal of Cardiology: Heart & Vasculature
• Subjects: Central sleep apnea; Atrial fibrillation; Pathophysiological mechanisms; Therapeutic options; Phrenic nerve stimulation
• Online Access: http://www.sciencedirect.com/science/article/pii/S2352906719302775

Precipitating factors and chronic diseases associated with atrial fibrillation (AF) are detailed in the literature. Emerging evidence over the last several decades suggests a potential causal relationship between central sleep apnea (CSA) and AF. Mechanisms including apnea-induced hypoxia with intermittent arousal, fluctuating levels of carbon dioxide, enhanced sympathetic/neurohormonal activation and oxidative stress causing inflammation have been implicated as etiologic causes of AF within this subpopulation. CSA affects the efficacy of pharmacologic and catheter-based antiarrhythmic treatments, which is why treating CSA prior to these interventions may lead to lower rates of AF. Subsequently, a reduction in the AF burden with transvenous phrenic nerve stimulation (TPNS) has become a topic of interest. The present review describes the relationship between these conditions, pathophysiologic mechanisms implicating the role of CSA in development of AF, and emerging therapeutic interventions.