Obstructive Sleep Apnea in Patients Undergoing Catheter Ablation: Effect on Atrial Remodeling and Atrial Fibrillation Burden

Interview With Ghassan Bidaoui, MD 

© 2025 HMP Global. All Rights Reserved.

Any views and opinions expressed are those of the author(s) and/or participants and do not necessarily reflect the views, policy, or position of EP Lab Digest or HMP Global, their employees, and affiliates. 

Ghassan Bidaoui, MD, from the Tulane Research Innovation Arrhythmia and Discovery Institute (TRIAD) in New Orleans, Louisiana, discusses his upcoming presentation and what he is looking forward to at the Western Atrial Fibrillation Symposium. 

Can you explain how obstructive sleep apnea (OSA) contributes to atrial remodeling and how this impacts the success of catheter ablation procedures for atrial fibrillation (AF)?

OSA has been shown to be prevalent and commonly found in patients with AF compared to patients without AF. So, it's very important to tackle this and assess how it affects atrial remodeling in patients. One thing that is important to note is that OSA is a disease that poses systematic effects on the body, so it leads to hypoxia and hypercapnia throughout sleep, usually on a daily basis. It can lead to increased inflammation and reactive oxygen species, as well as have a physical impact on the left atrium, which can lead to atrial fibrosis development and left atrium dilation. These are 2 components that are very important in inducing AF and that lead to its progression. It has also been found to affect patients who have already been diagnosed with AF as well as impact catheter ablation outcomes. For example, atrial fibrosis has been shown in a randomized fashion to induce recurrence of AF after ablation, especially in persistent AF patients.

What are the primary challenges in managing patients with OSA?

The primary challenge in treating and managing patients with OSA is that the condition goes underdiagnosed. Many patients, especially with mild OSA, do not have symptoms. They do not experience the daytime sleepiness that patients often complain about. Diagnosis of OSA can be difficult. It requires patients to go to a sleep lab in the hospital or clinic in order to be diagnosed. While home-based sleep tests are now available, they are not the gold standard, and this increases the complexity of OSA diagnosis for patients. 

The second thing is that OSA is a disease that comes with multiple comorbidities. Assessing OSA and its effect on other diseases is difficult and requires much more well-designed trials. 

Finally, although OSA is treated with CPAP, which is the gold standard, it is actually a difficult treatment for patients. It's very hard for patients to comply and adhere to the treatment on a daily basis. Hence, this may complicate the outcomes of these patients even further.

What strategies can improve outcomes for these patients?

That is a great question. The best strategy is to have comprehensive collaboration between sleep specialists and cardiologists. Cardiologists by themselves cannot manage OSA. We need sleep specialists to offer other treatments for sleep apnea based on the cause of the OSA. Hence, there should be a multifaceted approach with multiple specialties focusing on the patient. 

Second, it's also important to ensure that the patient is adhering to their treatment. If the patient is experiencing a problem with their CPAP, that should be identified in order to improve it.

Most importantly, there is a huge gap in the relationship between sleep apnea and cardiac remodeling. Few studies have a detailed analysis and assessment of OSA along with a detailed analysis and assessment of AF. Until now, we have not had studies that measured AF burden and polysomnography at the same time. If there has been, they are of a small sample size and require a longer follow-up.

Finally, what can we do now? We can ensure that patients are diagnosed early to prevent chronic and irreversible atrial remodeling, which can lead to persistent, high AF burden and lower efficacy of ablation regardless of what we do with OSA later on.

What are you most looking forward to at the 2025 Western AF Symposium?

This is my second time coming to Western AF! What is unique about this conference is that I do not have any fear of missing out on lectures since most of the lectures and presentations are in the same room. This does not often happen at other larger conferences. Also, the same faculty, along with many new people, join Western AF on a regular basis every year. This allows you to hear all the updates from experts across the US and Europe. 

Finally, the conference is focused only on AF, which is a very prevalent problem that requires our attention. I’m very excited to learn more. 

The transcripts have been edited for clarity and length.