Atrial fibrillation at the time of mitral transcatheter edge-to-edge repair for severe mitral regurgitation was associated with more than twice the risk of death or heart failure hospitalization at two years, according to a retrospective cohort study of 156 patients.
The study included consecutive patients with symptomatic heart failure and grade 3+ or 4+ MR who underwent mitral transcatheter edge-to-edge repair (M-TEER) between January 2021 and August 2023 at a single academic center. Of the 156 patients, 59 (37.8%) had Atrial fibrillation (AF) or atrial flutter documented on electrocardiography on the day of the procedure, while 97 (62.2%) were in sinus rhythm (SR), including 37 with a history of AF.
During a median follow-up of 12.5 months, the composite outcome of all-cause death or heart failure hospitalization (HFH) occurred in 64 patients, with a 2-year Kaplan–Meier estimated event rate of 41.0%. The rate was 52.5% in patients with AF and 33.0% in those in SR (unadjusted hazard ratio [HR], 1.88; 95% CI, 1.14–3.08; P=.01). After adjustment for clinical covariates, AF remained independently associated with the outcome.
The mean age of the cohort was 80.8 years (±8.8), and 82 patients (52.6%) were female. At baseline, 89.7% were in New York Heart Association class III. Procedural success, defined as achieving mitral regurgitation (MR) severity of ≤2+, was similar in both groups: 98.3% in AF and 96.9% in SR (P=.59).
Echocardiographic follow-up at a median of 6.0 months showed reductions in left ventricular end-diastolic volume index (LVEDVI), left atrial volume index (LAVI), and right ventricular systolic pressure (RVSP) in patients with SR, but not in those with AF. Instead, RVSP increased in the AF group. Left ventricular mass index decreased in both groups, while ejection fraction remained unchanged.
At follow-up, 18.6% of patients with AF had recurrent severe MR compared with 8.2% in SR (P=.05). Mortality was 15.3% in the AF group and 7.1% in SR (unadjusted HR, 2.30; 95% CI, 0.86–6.18; P=.10). HFH occurred in 47.5% of patients with AF versus 29.9% in SR. Stroke rates did not differ significantly.
Patients with AF were more likely to have secondary MR (72.9% vs 49.5%; P=.004), higher body mass index (26.8 vs 24.7 kg/m²; P=.04), and a history of stroke (27.1% vs 13.4%; P=.03). They were also more frequently prescribed beta blockers (86.4% vs 68.0%; P=.03) and loop diuretics (79.7% vs 63.9%; P=.04).
A sensitivity analysis excluding early postprocedural events confirmed that AF remained associated with adverse outcomes from 30 days to 2 years post-M-TEER.
“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,” concluded Carlo Mannina, MD, of the Icahn School of Medicine at Mount Sinai in New York, and one of the authors.
Full disclosures can be found in the published study.
Source: JAHA
