Atrial fibrillation (AF) is one of the most common clinical arrhythmias. Catheter ablation is an effective therapeutic strategy; however, recurrence rates remain substantial, ranging from 20% to 45%. Previous studies have established a strong association between obstructive sleep apnea (OSA) and the risk of AF recurrence following ablation. While continuous positive airway pressure (CPAP) is the standard intervention for OSA, and some observational studies suggest it may reduce post-ablation recurrence in patients with comorbid OSA, small randomized controlled trials have failed to confirm a clear benefit, potentially due to poor adherence.
This study aims to evaluate the clinical benefit of post-ablation CPAP therapy in AF patients with comorbid OSA.
Participants will:
* Be randomly assigned to either the CPAP group or the usual care group. * If in the CPAP group, use a CPAP device for 12 months. * Wear an ambulatory ECG recorder for a 7-day period at 3, 6, 9, and 12 months after randomization. * Complete follow-up checkups either at the clinic or over the phone at 1, 3, 6, and 12 months after randomization.
Age 18-75 years.
Patients with persistent AF who received catheter ablation for the first time.
Diagnosed with OSA.
Able to tolerate CPAP therapy.
Secondary AF.
Left atrial anteroposterior diameter 60mm (measured via parasternal long-axis view).
Left ventricular ejection fraction < 30%.
Comorbid moderate-to-severe mitral stenosis or history of prosthetic valve replacement (mechanical or bioprosthetic).
Parallel
Continuous Positive Airway Pressure (CPAP)
DeviceParticipants receive CPAP therapy provided by the research team. Treatment parameters are determined following auto-titrating or manual pressure titration. Prior to treatment initiation, participants receive training on device usage, mask fitting and adjustment, equipment cleaning and maintenance, and data transmission methods. Study physicians and technicians provide support to address any CPAP-related discomfort. 'Good adherence' is defined as device usage of ≥ 4 hours per night on ≥ 70% of days.
Usual Care
Other interventionParticipants receive standardized medical therapy for atrial fibrillation in accordance with international guidelines and clinical routine. For OSA management, researchers provide standardized health education. This includes informing participants about the risks associated with OSA and advising on lifestyle modifications, including weight loss, adopting a lateral sleeping position, and avoiding alcohol and sedatives.
Incidence of freedom from atrial arrhythmia recurrence.
Recurrence is defined as a composite of: 1. Any documented atrial arrhythmia (AF / Atrial Tachycardia \[AT\] / Atrial Flutter \[AFL\]) lasting 30 seconds after a 3-month blanking period; 2. Use of Class I or III AADs after the 3-month blanking period; 3. Cardioversion performed after the 3-month blanking period; 4. Repeat catheter ablation performed at any time.
Incidence of any documented atrial arrhythmia (AF/AFL/AT) lasting ≥30 seconds.
Incidence of documented AF lasting ≥30 seconds.
Incidence of documented AT lasting ≥30 seconds.
Incidence of documented AFL lasting ≥30 seconds.
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