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

Abstract

Background 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.Methods 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.Results 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).Conclusions 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.