Comparison of Outcome After Percutaneous Mitral Valve Repair With the MitraClip in Patients With Versus Without Atrial Fibrillation

Abstract

Percutaneous mitral valve repair with the MitraClip is an established treatment for patients with mitral regurgitation (MR) who are inoperable or at high risk for surgery. Atrial Fibrillation (AF) frequently coincides with MR, but only scarce data of the influence of AF on outcome after MitraClip is available. The aim of the current study was to compare the clinical outcome after MitraClip treatment in patients with versus without atrial fibrillation. Between January 2009 and January 2016, all consecutive patients treated with a MitraClip in 5 Dutch centers were included. Outcome measures were survival, symptoms, MR grade, and stroke incidence. In total, 618 patients were treated with a MitraClip. Patients with AF were older, had higher N-terminal B-type natriuretic peptide levels, more tricuspid regurgitation, less often coronary artery disease and a better left ventricular function. Survival of patients treated with the MitraClip was similar for patients with AF (82%) and without AF (non-AF; 85%) after 1 year (p = 0.30), but significantly different after 5-year follow-up (AF 34%; non-AF 47%; p = 0.006). After 1 month, 64% of the patients with AF were in New York Heart Association class I or II, in contrast to 77% of the patients without AF (p = 0.001). The stroke incidence appeared not to be significantly different (AF 1.8%; non-AF 1.0%; p = 0.40). In conclusion, patients with AF had similar 1-year survival, MR reduction, and stroke incidence compared with non-AF patients. However, MitraClip patients with AF had reduced long-term survival and remained more symptomatic compared with those without AF.

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

“…Compared with recent trials and registries, which report the prevalence of concomitant AF to be 27% to 70.2%, our study reveals the highest prevalence of AF (73.3%) in a TMVR cohort to date [1][2][3][4][8][9][10]. Regarding MR etiology, procedural characteristics, technical success, reduction of MR, and periprocedural mortality, we achieve to a high extent similar results, reflecting the comparability of our studied cohort to that of the last-mentioned published data.…”

“…In line with the published data, the patients with AF were more often >75 years old and predominantly male. Similar to the observation of Arora et al and Velu et al, the patients with AF had ischemic heart disease less frequently and thus received fewer previous percutaneous coronary interventions and cardiac bypass surgery [2,4].…”

“…us, recently published studies show a higher risk for bleeding and stroke, higher rates of heart failure hospitalizations, and finally a higher mortality of patients with concomitant AF undergoing TMVR [2][3][4]. is implies the essential need for additional strategies ameliorating the prognosis of these patients.…”

The impact of atrial fibrillation on transcatheter mitral valve repair outcomes: A propensity‐matched analysis

“…The relatively low post‐TMVR adverse event rate underlines the safety of the MitraClip procedure in “real‐world” practice regardless of the initial rhythm. Furthermore, our study confirms find­ings from the EVEREST II trial and previous studies by Hermann et al, Jabs et al, and Velu et al…”

“…AF may pose a technical challenge during TMVR given the irregularity of valve leaflet movements. However, conflicting results were reported on the impact of AF on TMVR outcomes …”