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Inadequate sleep duration is associated with higher risk of atrial flutter recurrence after ablationShort or long sleep may increase risk of heart rhythm issues

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Key Takeaway
Note that inadequate sleep is associated with higher risk of atrial flutter recurrence following catheter ablation.

This multicentre randomized controlled trial enrolled 720 patients undergoing catheter ablation for atrial fibrillation to evaluate the impact of nocturnal sleep duration on arrhythmia recurrence. Sleep was categorized as adequate (6-8 h/day) or inadequate (<6 h/day or >8 h/day).

The primary outcome, risk of recurrent arrhythmias including both AF and atrial flutter, showed no significant association with sleep duration (HR = 0.99; 95% CI 0.70-1.41). There were 226 incident cases of AF relapse recorded during the study period.

Secondary outcomes revealed that inadequate sleep was associated with a higher risk of atrial flutter recurrence (HR = 1.87; 95% CI 1.18-2.96) among all patients. Specifically, in patients with persistent AF at baseline, inadequate sleep was associated with a significantly higher risk of atrial flutter recurrence (HR = 3.42; 95% CI 1.47-7.97).

Safety and tolerability data were not reported. A notable limitation is that the study was only single-blinded. While the trial was originally designed to evaluate a Mediterranean diet, sleep duration served as an observed variable. These results suggest that while general AF recurrence may not be affected by sleep, specific atrial flutter outcomes might be influenced by this modifiable behavior.

How this fits prior evidence

How this fits prior evidence: This finding addresses a gap in understanding post-ablation outcomes by identifying sleep as a potential behavioral factor influencing arrhythmia. It complements the established efficacy of catheter ablation for managing arrhythmias mentioned in previous coverage regarding pregnant women, though it specifically highlights how patient lifestyle factors like sleep duration may influence specific recurrence types such as atrial flutter.

For many people living with atrial fibrillation, getting the right amount of sleep is a vital part of managing their health. A large study of 720 patients undergoing catheter ablation found that while total sleep duration did not change the overall rate of atrial fibrillation returning, it did have a significant impact on another condition called atrial flutter.

Patients who had inadequate sleep—defined as less than 6 hours or more than 8 hours per day—showed a much higher risk of experiencing recurring atrial flutter. This risk was especially high for those who already had persistent atrial fibrillation at the start of the study, where the risk of recurrence nearly tripled for those with poor sleep habits.

While this research highlights how important consistent sleep is for heart health, it is important to note that the study was not specifically designed to test sleep. Because it was a single-blind trial and sleep was an observed factor rather than a controlled intervention, these results should be discussed with a doctor to see how they apply to your specific treatment plan.

What this means for you:
Inadequate sleep (under 6 or over 8 hours) is linked to a higher risk of atrial flutter after heart surgery.

Common questions

How does my sleep affect my heart rhythm after surgery?

While the study did not find a significant link between total sleep duration and the return of atrial fibrillation, it did show that inadequate sleep (less than 6 or more than 8 hours) was associated with a higher risk of atrial flutter. This is especially true for patients who had persistent atrial fibrillation before their procedure.

What counts as 'inadequate' sleep in this study?

The researchers defined inadequate sleep as getting fewer than 6 hours of sleep per day or more than 8 hours per day. Patients falling into these categories showed a higher risk of atrial flutter recurrence compared to those who slept between 6 and 8 hours.

Is this finding certain for everyone with heart issues?

The study was an RCT, but it was not specifically designed to test sleep; sleep was an observed factor. Because of these limitations, you should talk to your doctor about how your specific sleep habits might affect your personal recovery and long-term heart health.

Study Details

Study typeRct
Sample sizen = 720
EvidenceLevel 2
PublishedJul 2026
View Original Abstract ↓
Background: Short and long sleep duration have been linked to atrial fibrillation (AF), but their influence on arrhythmia recurrence after catheter ablation is uncertain. We evaluated the association between nocturnal sleep duration and the risk of recurrent arrhythmias in patients undergoing catheter ablation for AF in the PREDIMAR trial. Methods: The PREDIMAR study is a multicentre, randomized, controlled, single-blind trial evaluating a Mediterranean diet enriched with extra-virgin olive oil for preventing arrhythmia recurrence after catheter ablation for AF. Nocturnal sleep duration was categorized as adequate (6?8 h/day) or inadequate (<6 h/day or >8 h/day). Multivariable Cox regression models estimated the association between sleep duration and the risk of recurrent atrial flutter (AFL) or AF. Results: Among 720 participants, we observed 226 incident cases of AF relapse and 107 cases of AFL. Inadequate nocturnal sleep duration was associated with a significantly higher risk of AFL recurrence compared with adequate sleep (adjusted HR = 1.87; 95% CI 1.18?2.96). No significant association was observed for AF recurrence (HR = 0.99; 95% CI 0.70?1.41). The association with AFL recurrence was particularly evident in patients with persistent AF at baseline before ablation (adjusted HR = 3.42; 95% CI 1.47?7.97), whereas no significant relationship was observed in those with baseline paroxysmal AF. Conclusions: Inadequate nocturnal sleep duration (<6 h/day or >8 h/day) may increase the risk of AFL recurrence following AF ablation. These findings highlight the relevance of sleep habits as a modifiable behavioural factor potentially influencing post-ablation outcomes.
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