European Heart Journal Advance Access originally published online on June 7, 2006
European Heart Journal 2006 27(14):1755; doi:10.1093/eurheartj/ehl068
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Clinical outcomes after direct current cardioversion of atrial tachyarrhythmias
Cardiology Department
Cardiac Arrhythmia and Electrophysiology Unit
Complejo Hospitalario de Jaén
Pza de Curtidores No. 2, 4°Dcha
23007 Jaén
Spain
Tel: +34 637463857
Fax: +34 953270692
E-mail address: maapalomares{at}secardiologia.es
Cardiology Department
Cardiac Arrhythmia and Electrophysiology Unit
Complejo Hospitalario de Jaén
Jaén
Spain
Cardiology Department
Cardiac Arrhythmia and Electrophysiology Unit
Complejo Hospitalario de Jaén
Jaén
Spain
Neumology Department
Hospital Universitario Son Dureta
Palma de Mallorca
Spain
Neumology Department
Hospital Universitario La Paz
Madrid
Spain
We read with great interest the paper by Elesber et al.1 of relapse and mortality after successful direct current cardioversion in elderly patients presenting either new-onset or recurrent persistent atrial tachyarrhythmias.
The findings of the present study merit several comments with respect to the potential influence of sleep-disordered breathing in the patients studied. Obstructive sleep apnoea (OSA) syndrome is a condition extremely prevalent and a large percentage of OSA patients are undiagnosed and untreated. Although symptomatic OSA is most common in middle-aged persons with a sharp decline in the older population, it is possible that this fact might be due to under-reporting of symptoms in elderly patients though it remains unclear.2 However, some authors have reported that sleep-disordered breathing is also very frequent in older persons.3 Cardiovascular disturbances are the most important complications in OSA patients producing severe morbidity and mortality, especially in untreated patients.4
A high prevalence of OSA has been demonstrated in patients with atrial fibrillation.5 Importantly, among OSA patients, in those correctly treated with continuous positive airway pressure who underwent direct current cardioversion for atrial fibrillation, a significant reduction in the recurrence rate for atrial fibrillation of nearly 50% has been reported.6 On the other hand, obesity is the main risk factor for developing OSA and a large proportion of obese patients are affected by OSA.7 Approximately one-third of Americans older than 60 years of age have obesity and that prevalence of obesity in elderly subjects will likely continue to increase.
In our opinion, it would be of interest to have data on both body weight and sleep parameters for patients with new-onset or recurrent atrial tachyarrhythmia because the diagnosis and correct treatment of sleep-disordered breathing might have modified the results of the present study in terms of arrhythmia relapse and mortality rates.
References
- Elesber AA, Rosales AG, Herges RM, Shen WK, Moon BS, Malouf JF, Ammash NM, Somers V, Hodge DO, Gersh BJ, Hammill SC, Friedman PA. (2006) Relapse and mortality following cardioversion of new-onset vs. recurrent atrial fibrillation and atrial flutter in the elderly. Eur Heart J. Published online ahead of print February 2.
- Groth M. (2005) Sleep apnea in the elderly. Clin Geriatr Med 21:701–712.[CrossRef][Medline]
- Endeshaw YW, Johnson TM, Kutner MH, Ouslander JG, Bliwise DL. (2004) Sleep-disordered breathing and nocturia in older adults. J Am Geriatr Soc 52:957–960.[Medline]
- Marin JM, Carrizo SJ, Vicente E, Agusti AG. (2005) Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 365:1046–1053.[ISI][Medline]
- Gami AS, Pressman G, Caples SM, Kanagala R, Gard JJ, Davison DE, Malouf JF, Ammash NM, Friedman PA, Somers VK. (2004) Association of atrial fibrillation and obstructive sleep apnea. Circulation 110:364–367.
[Abstract/Free Full Text] - Kanagala R, Murali NS, Friedman PA, Ammash NM, Gersh BJ, Ballman KV, et al. (2003) Obstructive sleep apnea and the recurrence of atrial fibrillation. Circulation 107:2589–2594.
[Abstract/Free Full Text] - Vgontzas AN, Tan TL, Bixler EO, Martin LF, Shubert D, Kales A. (1994) Sleep apnea and sleep disruption in obese patients. Arch Intern Med 154:1705–1711.[Abstract]
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||