Transcatheter Mitral Valve Repair Improves Conduction and Function in a CRT Candidate.

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Electrophysiology

Background:

• Dilated cardiomyopathy (DCM) with severe mitral regurgitation (MR) and left bundle branch block (LBBB) often necessitates cardiac resynchronization therapy (CRT).
• Device-related complications can limit CRT's use in high-risk patients.
• Identifying alternative treatment strategies is crucial for managing these complex cardiac conditions.

Observation:

• A 77-year-old woman with DCM, severe MR, and LBBB was deemed high-risk for CRT complications.
• She underwent mitral valve transcatheter edge-to-edge repair (M-TEER) as an alternative initial strategy.
• Post-M-TEER, the patient experienced significant symptom improvement, enhanced left ventricular function, and a notable reduction in QRS duration.

Findings:

• M-TEER demonstrated efficacy in improving clinical status and cardiac function in a patient with DCM, severe MR, and LBBB.
• An unexpected and significant reduction in QRS duration was observed following M-TEER.
• This suggests M-TEER may induce both mechanical and electrical reverse remodeling.

Implications:

• M-TEER can be considered as a viable initial therapeutic option for select patients with DCM, severe MR, and LBBB when CRT is contraindicated or high-risk.
• The observed QRS duration reduction warrants further investigation into the electrical effects of M-TEER.
• This approach may offer a valuable alternative, potentially improving outcomes and reducing CRT-related risks in this patient population.