Impact of Atrial Fibrillation in Patients With Severe Mitral Regurgitation Undergoing Transcatheter Edge-to-Edge...

Atrial fibrillation (AF) and mitral regurgitation (MR) are closely linked, and one may worsen the other. We investigated the impact of baseline AF in patients with MR undergoing transcatheter edge-to-edge repair.

One-hundred-fifty-six consecutive patients with symptomatic heart failure (HF) undergoing mitral valve transcatheter edge-to-edge repair for severe MR were studied. The primary end point was the composite outcome of death or HF hospitalization. Transthoracic echocardiograms were performed at baseline and follow-up.

Mean age was 80.8±8.8 years and 82 (52.6%) patients were female. MR cause was primary in 69 (44.2%) and secondary in 87 (55.8%) patients. AF or atrial flutter was present in 59 (37.8%) patients at baseline. Mitral valve transcatheter edge-to-edge repair was successful (≤2+ MR) in 58 (98.3%) and 94 (96.9%) patients with and without AF respectively (P=0.59). During median 12.5 months follow-up, the primary end point occurred in 64 patients (2-year Kaplan-Meier estimated rate 41.0%), including death in 16 patients (10.3%) and HF hospitalization in 57 patients (36.5%). Baseline AF remained a significant independent predictor of death or HF hospitalization (adjusted hazard ratio, 2.03 [95% CI, 1.12-3.69], P=0.02). Left ventricular end-diastolic volume, left atrial volume, and right ventricular systolic pressure decreased during follow-up among patients in sinus rhythm but not among those in AF. AF was associated with an increased risk of severe MR recurrence (18.6% versus 8.2%, P=0.05).

In patients with HF and severe MR treated with Mitral valve transcatheter edge-to-edge repair, baseline AF was associated with impaired right and left heart remodeling, more frequent MR recurrence, and more than doubling of the 2-year risk of death or HF hospitalization.