{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T06:15:31Z","timestamp":1790835331062,"version":"4.1.0"},"reference-count":22,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2021,1,14]],"date-time":"2021-01-14T00:00:00Z","timestamp":1610582400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"The National Health and Medical Research Council"},{"name":"Practitioner fellowships"},{"DOI":"10.13039\/501100000925","name":"NHMRC","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007497","name":"Biosense Webster","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007497","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008497","name":"Boston Scientific","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008497","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000046","name":"Abbott","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000046","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004374","name":"Medtronic","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004374","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008497","name":"Boston Scientific","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008497","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007497","name":"Biosense Webster","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007497","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,5,21]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>Obstructive sleep apnoea (OSA) associates with atrial fibrillation (AF), but the relationship of OSA severity and AF phenotype with the atrial substrate remains poorly defined. We sought to define the atrial substrate across the spectrum of OSA severity utilizing high-density mapping.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>Sixty-six consecutive patients (male 71%, age 61\u2009\u00b1\u20099) having AF ablation (paroxysmal AF 36, persistent AF 30) were recruited. All patents underwent formal overnight polysomnography and high-density left atrial (LA) mapping (mean 2351\u2009\u00b1\u20091244 points) in paced rhythm. Apnoea\u2013hypopnoea index (AHI) (mean 21\u2009\u00b1\u200918) associated with lower voltage (\u22120.34, P\u2009=\u20090.005), increased complex points (r\u2009=\u20090.43, P\u2009&amp;lt;\u20090.001), more low-voltage areas (r\u2009=\u20090.42, P\u2009&amp;lt;\u20090.001), and greater voltage heterogeneity (r\u2009=\u20090.39, P\u2009=\u20090.001), and persisted after multivariable adjustment. Atrial conduction heterogeneity (r\u2009=\u20090.24, P\u2009=\u20090.025) but not conduction velocity (r = \u22120.09, P\u2009=\u20090.50) associated with AHI. Patchy regions of low voltage that co-localized with slowed conduction defined the atrial substrate in paroxysmal AF, while a diffuse atrial substrate predominated in persistent AF. The association of AHI with remodelling was most apparent among paroxysmal AF [LA voltage: paroxysmal AF \u22120.015 (\u22120.025, \u22120.005), P\u2009=\u20090.004 vs. persistent AF \u22120.006 (\u22120.017, 0.005), P\u2009=\u20090.30]. Furthermore, in paroxysmal AF an AHI \u2265 30 defined a threshold at which atrial remodelling became most evident (nil\u2013mild vs. moderate vs. severe: 1.92\u2009\u00b1\u20090.42\u2009mV vs. 1.84\u2009\u00b1\u20090.28\u2009mV vs. 1.34\u2009\u00b1\u20090.41\u2009mV, P\u2009=\u20090.006). In contrast, significant remodelling was observed across all OSA categories in persistent AF (1.67\u2009\u00b1\u20090.55\u2009mV vs. 1.50\u2009\u00b1\u20090.66\u2009mV vs. 1.55\u2009\u00b1\u20090.67\u2009mV, P\u2009=\u20090.82).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>High-density mapping observed that OSA associates with marked atrial remodelling, predominantly among paroxysmal AF cohorts with severe OSA. This may facilitate the identification of AF patients that stand to derive the greatest benefit from OSA management.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/europace\/euaa275","type":"journal-article","created":{"date-parts":[[2021,1,6]],"date-time":"2021-01-06T18:33:31Z","timestamp":1609958011000},"page":"691-700","source":"Crossref","is-referenced-by-count":28,"title":["Sleep apnoea has a dose-dependent effect on atrial remodelling in paroxysmal but not persistent atrial fibrillation: a high-density mapping study"],"prefix":"10.1093","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7894-0332","authenticated-orcid":false,"given":"Chrishan Joseph","family":"Nalliah","sequence":"first","affiliation":[{"name":"Department of Cardiology, Royal Melbourne Hospital, Melbourne 3050, Australia"},{"name":"Department of Medicine and Physiology, The University of Melbourne, Melbourne, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geoffrey R","family":"Wong","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Royal Melbourne Hospital, Melbourne 3050, Australia"},{"name":"Department of Medicine and Physiology, The University of Melbourne, Melbourne, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geoffrey","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Royal Melbourne Hospital, Melbourne 3050, Australia"},{"name":"Department of Medicine and Physiology, The University of Melbourne, Melbourne, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleksandr","family":"Voskoboinik","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Melbourne, Australia"},{"name":"Department of Cardiology, The Alfred Hospital, Melbourne, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirk","family":"Kee","sequence":"additional","affiliation":[{"name":"Department of Medicine and Physiology, The University of Melbourne, Melbourne, Australia"},{"name":"Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Melbourne, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy","family":"Goldin","sequence":"additional","affiliation":[{"name":"Department of Medicine and Physiology, The University of Melbourne, Melbourne, Australia"},{"name":"Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Melbourne, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Troy","family":"Watts","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Royal Melbourne Hospital, Melbourne 3050, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominik","family":"Linz","sequence":"additional","affiliation":[{"name":"Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Wirth","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Royal Melbourne Hospital, Melbourne 3050, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramanathan","family":"Parameswaran","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Royal Melbourne Hospital, Melbourne 3050, Australia"},{"name":"Department of Medicine and Physiology, The University of Melbourne, Melbourne, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hariharan","family":"Sugumar","sequence":"additional","affiliation":[{"name":"Department of Medicine and Physiology, The University of Melbourne, Melbourne, Australia"},{"name":"Department of Cardiology, The Alfred Hospital, Melbourne, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandeep","family":"Prabhu","sequence":"additional","affiliation":[{"name":"Department of Medicine and Physiology, The University of Melbourne, Melbourne, Australia"},{"name":"Department of Cardiology, The Alfred Hospital, Melbourne, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"McLellan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Royal Melbourne Hospital, Melbourne 3050, Australia"},{"name":"Department of Medicine and Physiology, The University of Melbourne, Melbourne, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Han","family":"Ling","sequence":"additional","affiliation":[{"name":"Department of Medicine and Physiology, The University of Melbourne, Melbourne, Australia"},{"name":"Department of Cardiology, The Alfred Hospital, Melbourne, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Joseph","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Royal Melbourne Hospital, Melbourne 3050, Australia"},{"name":"Department of Medicine and Physiology, The University of Melbourne, Melbourne, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph B","family":"Morton","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Royal Melbourne Hospital, Melbourne 3050, Australia"},{"name":"Department of Medicine and Physiology, The University of Melbourne, Melbourne, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Kistler","sequence":"additional","affiliation":[{"name":"Department of Medicine and Physiology, The University of Melbourne, Melbourne, Australia"},{"name":"Department of Cardiology, The Alfred Hospital, Melbourne, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prashanthan","family":"Sanders","sequence":"additional","affiliation":[{"name":"Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan M","family":"Kalman","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Royal Melbourne Hospital, Melbourne 3050, Australia"},{"name":"Department of Medicine and Physiology, The University of Melbourne, Melbourne, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,1,14]]},"reference":[{"key":"2021052120441213000_euaa275-B1","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1161\/01.CIR.0000136587.68725.8E","article-title":"Association of atrial fibrillation and obstructive sleep apnea","volume":"110","author":"Gami","year":"2004","journal-title":"Circulation"},{"key":"2021052120441213000_euaa275-B2","doi-asserted-by":"crossref","first-page":"1662","DOI":"10.1093\/eurheartj\/ehn214","article-title":"Prevalence of sleep disordered breathing in paroxysmal and persistent atrial fibrillation patients with normal left ventricular function","volume":"29","author":"Stevenson","year":"2008","journal-title":"Eur Heart J"},{"key":"2021052120441213000_euaa275-B3","doi-asserted-by":"crossref","first-page":"910","DOI":"10.1164\/rccm.200509-1442OC","article-title":"Association of nocturnal arrhythmias with sleep-disordered breathing: the Sleep Heart Health Study","volume":"173","author":"Mehra","year":"2006","journal-title":"Am J Respir Crit Care Med"},{"key":"2021052120441213000_euaa275-B4","doi-asserted-by":"crossref","first-page":"2589","DOI":"10.1161\/01.CIR.0000068337.25994.21","article-title":"Obstructive sleep apnea and the recurrence of atrial fibrillation","volume":"107","author":"Kanagala","year":"2003","journal-title":"Circulation"},{"key":"2021052120441213000_euaa275-B5","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1016\/j.jacc.2013.03.052","article-title":"Treatment of obstructive sleep apnea reduces the risk of atrial fibrillation recurrence after catheter ablation","volume":"62","author":"Fein","year":"2013","journal-title":"J Am Coll Cardiol"},{"key":"2021052120441213000_euaa275-B6","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/j.ijcard.2018.11.100","article-title":"The impact of continuous positive airway pressure treatment on the recurrence of atrial fibrillation post cardioversion: a randomized controlled trial","volume":"278","author":"Caples","year":"2019","journal-title":"Int J Cardiol"},{"key":"2021052120441213000_euaa275-B7","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1016\/j.hrthm.2011.10.017","article-title":"Atrial remodeling in obstructive sleep apnea: implications for atrial fibrillation","volume":"9","author":"Dimitri","year":"2012","journal-title":"Heart Rhythm"},{"key":"2021052120441213000_euaa275-B8","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCEP.117.005407","article-title":"Atrial substrate and triggers of paroxysmal atrial fibrillation in patients with obstructive sleep apnea","volume":"10","author":"Anter","year":"2017","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"2021052120441213000_euaa275-B9","article-title":"2017 HRS\/EHRA\/ECAS\/APHRS\/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation","author":"Calkins","journal-title":"Europace"},{"key":"2021052120441213000_euaa275-B10","doi-asserted-by":"crossref","first-page":"479","DOI":"10.5664\/jcsm.6506","article-title":"Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine Clinical Practice Guideline","volume":"13","author":"Kapur","year":"2017","journal-title":"J Clin Sleep Med"},{"key":"2021052120441213000_euaa275-B11","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1161\/CIRCEP.114.002737","article-title":"High-resolution mapping of scar-related atrial arrhythmias using smaller electrodes with closer interelectrode spacing","volume":"8","author":"Anter","year":"2015","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"2021052120441213000_euaa275-B12","doi-asserted-by":"crossref","first-page":"881","DOI":"10.1111\/jce.13472","article-title":"Accuracy of left atrial bipolar voltages obtained by ConfiDENSE multielectrode mapping in patients with persistent atrial fibrillation","volume":"29","author":"Maille","year":"2018","journal-title":"J Cardiovasc Electrophysiol"},{"key":"2021052120441213000_euaa275-B13","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1016\/j.compbiomed.2015.04.027","article-title":"Techniques for automated local activation time annotation and conduction velocity estimation in cardiac mapping","volume":"65","author":"Cantwell","year":"2015","journal-title":"Comput Biol Med"},{"key":"2021052120441213000_euaa275-B14","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1016\/j.hrthm.2018.10.041","article-title":"Moderate alcohol consumption is associated with atrial electrical and structural changes: insights from high-density left atrial electroanatomic mapping","volume":"16","author":"Voskoboinik","year":"2019","journal-title":"Heart Rhythm"},{"key":"2021052120441213000_euaa275-B15","doi-asserted-by":"crossref","first-page":"1027","DOI":"10.1109\/10.855929","article-title":"Estimation of 3-D conduction velocity vector fields from cardiac mapping data","volume":"47","author":"Barnette","year":"2000","journal-title":"IEEE Trans Bio-Med Eng"},{"key":"2021052120441213000_euaa275-B16","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1109\/10.668746","article-title":"Estimation of conduction velocity vector fields from epicardial mapping data","volume":"45","author":"Bayly","year":"1998","journal-title":"IEEE Trans Biomed Eng"},{"key":"2021052120441213000_euaa275-B17","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1016\/j.amjcard.2012.03.037","article-title":"Relation of the severity of obstructive sleep apnea in response to anti-arrhythmic drugs in patients with atrial fibrillation or atrial flutter","volume":"110","author":"Monahan","year":"2012","journal-title":"Am J Cardiol"},{"key":"2021052120441213000_euaa275-B18","doi-asserted-by":"crossref","first-page":"930","DOI":"10.1111\/jce.12468","article-title":"Long-term outcome of catheter ablation in atrial fibrillation patients with coexistent metabolic syndrome and obstructive sleep apnea: impact of repeat procedures versus lifestyle changes","volume":"25","author":"Mohanty","year":"2014","journal-title":"J Cardiovasc Electrophysiol"},{"key":"2021052120441213000_euaa275-B19","doi-asserted-by":"crossref","first-page":"1001","DOI":"10.1111\/jce.12981","article-title":"Obstructive sleep apnea treatment and atrial fibrillation: a need for definitive evidence","volume":"27","author":"Nalliah","year":"2016","journal-title":"J Cardiovasc Electrophysiol"},{"key":"2021052120441213000_euaa275-B20","doi-asserted-by":"crossref","first-page":"2050","DOI":"10.1001\/jama.2013.280521","article-title":"Effect of weight reduction and cardiometabolic risk factor management on symptom burden and severity in patients with atrial fibrillation: a randomized clinical trial","volume":"310","author":"Abed","year":"2013","journal-title":"JAMA"},{"key":"2021052120441213000_euaa275-B21","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1016\/j.hrthm.2015.08.019","article-title":"Proven isolation of the pulmonary vein antrum with or without left atrial posterior wall isolation in patients with persistent atrial fibrillation","volume":"13","author":"Bai","year":"2016","journal-title":"Heart Rhythm"},{"key":"2021052120441213000_euaa275-B22","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1111\/jce.12870","article-title":"Box isolation of fibrotic areas (BIFA): a patient-tailored substrate modification approach for ablation of atrial fibrillation","volume":"27","author":"Kottkamp","year":"2016","journal-title":"J Cardiovasc Electrophysiol"}],"container-title":["EP Europace"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/europace\/article-pdf\/23\/5\/691\/38096316\/euaa275.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/europace\/article-pdf\/23\/5\/691\/38096316\/euaa275.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,5,21]],"date-time":"2021-05-21T20:47:09Z","timestamp":1621630029000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/europace\/article\/23\/5\/691\/6099039"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,14]]},"references-count":22,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2021,1,14]]},"published-print":{"date-parts":[[2021,5,21]]}},"URL":"https:\/\/doi.org\/10.1093\/europace\/euaa275","relation":{},"ISSN":["1099-5129","1532-2092"],"issn-type":[{"value":"1099-5129","type":"print"},{"value":"1532-2092","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,5,1]]},"published":{"date-parts":[[2021,1,14]]}}}