Analysis of Atrial Fibrillation Treatment Regimes in a Multicenter Cohort of Transcatheter Edge-to-Edge Mitral Valve Repair Patients

Abstract

Background. Atrial fibrillation (AF) is a highly prevalent comorbidity in patients with severe mitral valve regurgitation (MR). Recent studies show a deleterious outcome of patients with concomitant AF after transcatheter mitral valve repair (TMVR). This underlines the essential need for additional strategies that ameliorate the prognosis of these patients. Fundamental data on AF characteristics and treatment regimes in this special cohort of patients are lacking. Methods. We retrospectively analyzed the data of 542 consecutive patients with severe MR undergoing TMVR in three tertiary heart centers with special focus on AF type and underlying treatment strategies. Results. The prevalence of concomitant AF was 73.3%, and AF did not affect the procedural success or the incidence of major adverse cardiac and cerebrovascular events. The patients with AF were more frequently >75 years, had more tricuspid regurgitation, and less coronary artery disease than non-AF patients. The distribution of AF types was 32% paroxysmal AF, 27% persistent AF, and 41% permanent AF. Except for a higher degree in severe tricuspid regurgitation and a higher likelihood of male sex, no substantial differences were observed while comparing permanent and nonpermanent AF patients. The predominant treatment regime was rate control (57%), with only beta blockers (BB) in the majority of persistent and permanent AF patients, while additional digitalis or a pacemaker was used infrequently. Rhythm control was mainly achieved with BB alone in paroxysmal AF patients and with additional antiarrhythmic drugs in the majority of persistent AF patients. Interventional rhythm control therapy was performed in 2.5% and 30.9% of paroxysmal and persistent AF patients, respectively. The guideline-adherent use of oral anticoagulants was comparable and high in both groups (91.9% in nonpermanent vs. 90.1% in permanent AF). Conclusion. This is the first study to provide necessary information for the understanding of the current clinical practice in dealing with TMVR patients. Since evidence suggests that AF is not a benign concomitant disease, further investigations are needed to assess the prognostic impact of these different AF treatment strategies.

Impact of Rhythm vs. Rate Control in Atrial Fibrillation on the Long-Term Outcome of Patients Undergoing Transcatheter Edge-to-Edge Mitral Valve Repair

“…Thirty-six patients (6.6%) were excluded from further analysis due to an unsuccessful procedure. As previously reported, 373 (73.3%) patients of the analyzed cohort suffered from coexistent AF, with the presence of AF not correlating with the success of the TMVR procedure (Odds Ratio (OR) 0.62, 95%-CI, 0.29-1.39, p = 0.27) [4]. Apart from this, the incidence of MACCE and the in-hospital death from any cause did not differ significantly in AF and non-AF patients (15/373 (3.5%) vs. 7/133 (5.3%), p = 0.4; 15/373 (4.0%) vs. 6/133 (4.5%), p = 0.8).…”

“…Data from all consecutive patients scheduled for percutaneous therapy of MR using the MitraClip ® device in three tertiary heart centers in Germany between October 2011 and May 2020 were collected in registries in each hospital and subsequently pooled for analysis. Details on patient selection, procedural aspects as well as details on definitions of AF types and therapies have recently been published [4,12]. In brief, the definition of AF types has been made in accordance with the guidelines of the European Society of Cardiology [13].…”

“…For this specific cohort, transcatheter edge-to-edge repair with the MitraClip ® device (Abbott Vascular, Santa Clara, CA, USA) has proven to be an excellent treatment option, as it has been shown to be safe and effective in alleviating heart failure symptoms [2] and even mortality [3] in different MR etiologies. With a prevalence of up to 73.3% in real-world data, atrial fibrillation (AF) is exceedingly frequent and inseparably linked to MR [4]. This emphasizes in particular the complex pathophysiological interactions of these two important diseases.…”

Arrhythmias in Patients With Valvular Heart Disease: Gaps in Knowledge and the Way Forward

“…Once AF has become established, it induces a vicious circle of self-perpetuation through LA enlargement ( 49 ). Persistent and permanent AF are predominant patterns observed in degenerative MR ( 50 ), with considerable impact on mortality, but paroxysmal AF diagnosed by ECG is already associated with impaired outcome vs. SR ( 6 ), raising the issue of its detection by more sensitive methods. Fibrosis increases LA stiffness, affecting cardiac filling and output with heightened risk of fibrotic atrial cardiomyopathy ( 48 ).…”

Endothelial dysfunction predicted cardiovascular events in patients with paroxysmal atrial fibrillation

“…10 Similar to the methods used in our previous study, FMD was determined by a VIVID 8 ultrasound system )GE Medical Systems(. 11 After baseline brachial artery diameter was measured, a forearm blood pressure cuff was inflated to 225 mmHg for 5 minutes. Ultrasound images of the brachial artery were recorded to obtain end-diastolic pre-occlusion baseline diameter and to determine the maximum post-occlusion brachial artery diameter.…”