Among 720 participants in the PREDIMAR randomized controlled trial — a Mediterranean diet intervention study tracking arrhythmia recurrence after catheter ablation for atrial fibrillation — inadequate nocturnal sleep (defined as fewer than 6 or more than 8 hours per night) was independently associated with an 87% higher risk of atrial flutter recurrence (adjusted HR = 1.87; 95% CI 1.18–2.96). The effect was dramatically amplified in patients who had persistent AF before ablation, reaching a 3.42-fold elevated risk. Notably, no significant association emerged for AF recurrence itself.
This finding deserves careful contextual framing. Catheter ablation is increasingly the preferred rhythm-control strategy for AF, yet recurrence rates remain frustratingly high — typically 30–50% within two years. Most post-ablation research targets structural or procedural variables; behavioral factors like sleep are chronically underexplored in this population. The mechanistic pathway likely involves autonomic nervous system dysregulation and inflammatory signaling, both well-documented consequences of sleep disruption that can destabilize atrial electrophysiology.
The divergence between AFL and AF recurrence outcomes is intriguing and biologically unexplained — a limitation the authors do not fully resolve. Sleep duration was self-reported, introducing measurement error, and the bidirectional relationship between arrhythmia burden and sleep quality makes causal inference difficult. As a preprint posted on medRxiv and not yet peer-reviewed, these results require independent replication before clinical translation. Still, the finding is clinically actionable: sleep assessment costs nothing and may meaningfully stratify post-ablation risk.
