Ventricular arrhythmias in patients with functional mitral regurgitation and implantable cardiac devices: implications of mitral valve repair with Mitraclip®

Abstract

Background: Limited information has been reported regarding the impact of percutaneous mitral valve repair (PMVR) on ventricular arrhythmic (VA) burden. The aim of this study was to address the incidence of VA and appropriate antitachycardia implantable cardiac defibrillator (ICD) therapies before and after PMVR. Methods:We retrospectively analyzed all consecutive patients with heart failure with reduce left ventricular ejection fraction (LVEF), functional mitral regurgitation (FMR) grade 3+ or 4+ and an active ICD or cardiac resynchronizer who underwent PMVR in any of the eleven recruiting centers. Only patients with complete available device VA monitoring from one-year before to one year after PMVR were included. Baseline clinical and echocardiographic characteristics were collected before PMVR and at 12-months follow-up.Results: Ninety-three patients (68.2±10.9 years old, male 88.2%) were enrolled. PMVR was successfully performed in all patients and device success at discharge was 91.4%. At 12-month follow-up, we observed a significant reduction in mitral regurgitation severity, NT-proBNP and prevalence of severe pulmonary hypertension and severe kidney disease. Patients also referred a significant improvement in NYHA functional class and showed a non-significant trend to reserve left ventricular remodeling. After PMVR a significant decrease in the incidence of non-sustained ventricular tachycardia (VT) (5.0±17.8 vs. 2.7±13.5, P=0.002), sustained VT or ventricular fibrillation (0.9±2.5 vs. 0.5±2.9, P=0.012) and ICD antitachycardia therapies (2.5±12.0 vs. 0.9±5.0, P=0.033) were observed.Conclusions: PMVR was related to a reduction in arrhythmic burden and ICD therapies in our cohort.

Impact of Percutaneous Mitral Valve Repair Using the MitraClipTM System on Ventricular Arrhythmias and ICD Therapies

“…The prevalence of ventricular arrhythmias in our study population was high and, in the context of advanced HF with severely reduced LVEF, more pronounced compared with previously published cohorts [ 13 , 14 , 15 ]. As VA incidence correlates with LVEF, a potential mechanism of VA reduction by TEER could be due to LVEF improvement.…”

“…The patients included in our study correspond to a real-world TEER-cohort with mainly functional MR due to cardiac remodelling in the context of advanced HF and thus very high surgical risk. The severely reduced LVEF and advanced LV dilatation of this cohort distinguishes our results from previous studies where less severe HF patients were included [ 13 , 14 , 15 ]. In addition, this cohort comprises a relevant percentage of patients with end-stage HF enlisted for cardiac transplantation, treated with MitraClip TM as bridge therapy [ 21 , 22 ].…”

“…In addition, this cohort comprises a relevant percentage of patients with end-stage HF enlisted for cardiac transplantation, treated with MitraClip TM as bridge therapy [ 21 , 22 ]. In total 21% (18/86) of the patients were listed for heart transplantation with a median age of 53 years, lowering the median age of the cohort comparing to earlier reports [ 13 , 14 , 15 ].…”

“…The present study investigated the impact of TEER using the MitraClip TM device on ventricular arrhythmias and ICD therapies. To date, only limited information regarding the effect of TEER on VA burden has been reported [ 13 , 14 , 15 ]. To the best of our knowledge, our study provides the longest follow-up information on ventricular arrhythmias after MitraClip TM therapy published so far.…”

“…To date, only limited information regarding the effect of TEER on VA burden has been reported [ 13 , 14 , 15 ]. Therefore, in the present study we investigated the impact of TEER on VA rates, ICD (Implantable Cardioverter Defibrillator) therapies and two-year survival rate in patients with severe symptomatic MR and HF with reduced ejection fraction (HFrEF).…”