Impact of atrial fibrillation on outcomes of patients treated by transcatheter mitral valve repair

Sun, Fuqiang; Liu, Honghao; Zhang, Qi; Lu, Fanfan; Zhan, Haibo; Zhou, Jiawei

doi:10.1097/md.0000000000022195

Cited by 6 publications

(10 citation statements)

References 42 publications

(46 reference statements)

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“…Underlining the otherwise comparability of the studied cohort, largely similar results were achieved regarding MR etiology, procedural characteristics, technical success, MR reduction and periprocedural MACCE. The already growing evidence of an adverse outcome of AF compared to non-AF patients, as reported for example by the groups of Velu, Keßler and Arora or by two recent meta-analyzes, were, thus, confirmed [5,6,8,14,15]. This, again, highlights the urgent need for additional strategies to improve the prognosis of this important and further growing cohort of patients.…”

Section: Discussionmentioning

confidence: 64%

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

Waechter

Ausbuettel

Chatzis

et al. 2021

JCM

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Atrial fibrillation (AF) is a highly prevalent comorbidity in patients with severe mitral valve regurgitation (MR) undergoing transcatheter mitral valve repair (TMVR) and has been shown to significantly worsen their outcome. However, data on the impact of AF treatment strategy in this rapidly growing cohort of patients is unknown. In a multicenter, observational cohort study, 542 consecutive patients undergoing TMVR were enrolled, and subsequently, comprehensive survival analyses according to AF status and therapy were performed using propensity score matching and Cox regression. In the analyzed cohort, 373 (73.3%) of the TMVR patients had concomitant AF. Of these patients, 212 (59%) were on rate control therapy and 161 (41%) were on rhythm control therapy. At 3 years, significantly reduced cumulative survival was observed for patients on rhythm compared to patients on rate control (46.7% (75/161) vs. 56.5% (91/161), p = 0.032). Amiodarone was used to a substantial extent for rhythm control and found to be an independent mortality predictor (Hazard Ratio 1.5, 95%CI 1.1–2.1, p = 0.04). The adverse outcome of concomitant AF in TMVR patients was confirmed (AF: 47.3% (126/266) vs. non-AF: 58.3% (78/133), p = 0.047). Rhythm control achieved almost exclusively pharmacologically is associated with an adverse outcome compared to the rate control of AF in TMVR. This raises awareness of the importance of AF and its treatment, as this seems to be a promising key point for improving the prognosis of TMVR patients.

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Section: Discussionmentioning

confidence: 64%

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

Waechter

Ausbuettel

Chatzis

et al. 2021

JCM

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“…In most cases, severe MR may not be treated due to the degree of sever ity, age, and co-morbid of the patients, and [5] complications of the surgical procedure. In such cases, mitraclip implantation is an established treatment option and plays an important role as it is a minimally invasive [2,6] procedure. It is also noted to have lesser complication rates [7] according to a study done by nickenig G et al Few other studies mentioned that atrial fibrillation (AF) is noted to be [3,5,8,9] one of the complications post mitraclip implantation.…”

Section: Discussionmentioning

confidence: 99%

The Onset of Atrial Fibrillation After Implantation of Mitraclip for Mitral Regurgitation: A Case Report

Agarwal¹,

Arjundas²

2021

PIJR

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BACKGROUND: Mitraclip procedure is an effective and minimally invasive approach for mitral regurgitation in patients of advanced age and high risk to surgical intervention. Even though it is approved by USFDA for the treatment of high-risk patients with primary mitral regurgitation (MR), complications like atrial fibrillation have been observed. The primary objective of this case report is to bring to notice the incidence of atrial fibrillation after mitraclip implantation. CASE REPORT: A 78-year-old patient with multiple co-morbidities like systemic hypertension, peripheral neuropathy, etc. presented with severe chest pain and found to have severe MR, severe pulmonary arterial hypertension, normal left ventricular function, an ejection fraction of 68% and was planned for mitraclip implantation procedure. A week after the mitraclip procedure, the patient was presented with atrial fibrillation. DISCUSSION: Thus there is a possibility of side effects such as atrial arrhythmias, and this can also alter the mortality rates. The occurrence of atrial fibrillation should be kept in mind and necessary precautions should be taken to prevent it.

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“…Transcatheter mitral valve repair Similar to its impact on MV surgery, pre-operative atrial fibrillation has also been associated with adverse long-term outcomes in patients undergoing transcatheter MV repair via MitraClip but with conflicting results on short-term outcomes such as in-hospital mortality, in-hospital complications and resource utilization [85][86][87][88][89][90] . One study reported greater in-hospital ischemic stroke, in-hospital hemorrhagic stroke, length of hospitalization, and increased 30-day mortality in patients with pre-operative atrial fibrillation undergoing repair with MitraClip compared to those without pre-operative atrial fibrillation.…”

Section: Mmentioning

confidence: 99%

“…However, both groups had a similar rate of stroke at 30day [89] . Although studies conflict on short-term outcomes, many report pre-operative atrial fibrillation as an independent predictor of 1-year mortality [86,87] and 3-year mortality with increased MACCE [91] . A multicenter study with 5-year follow-up also showed an association between atrial fibrillation and reduced long-term survival in patients with MitraClip repair but showed no difference in stroke incidence [92] .…”

Section: Mmentioning

confidence: 99%

Incidence, etiology, and outcomes of pre- and post-operative atrial fibrillation in mitral valve procedures: a review

Dokko¹,

Novotny²,

Santore³

et al. 2022

Vessel Plus

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Although pre-procedural and post-procedural atrial fibrillation occur commonly in mitral valve (MV) patients, the impact on patient outcomes and resource utilization has not been well documented. A comprehensive PubMed review was performed using a combination of MeSH terms related to atrial fibrillation, MV disease, MV and atrial fibrillation procedures, and medical management. Additional publications were selected from the reference lists of studies identified in the literature search. This review found that several studies conflict with the short-term outcomes associated with pre- and post-operative atrial fibrillation in MV patients. In general, both pre- and post-operative atrial fibrillation have clear negative long-term impacts on MV patients’ mortality and risk of stroke, major bleeding and other thromboembolic events. Surgical ablation for pre-operative atrial fibrillation and transcatheter ablation for medically resistant post-operative atrial fibrillation appears to be safe and effective procedure; these percutaneous and surgical interventions have been documented to mitigate MV-related thromboembolic risk. For MV patients, evidence suggests that the first step should be to optimize the current medical therapy; for persistent symptoms not addressed medically, ablation procedures should be considered. To optimize MV patients’ quality of care, however, additional research appears warranted to prevent long-term adverse outcomes.

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Impact of atrial fibrillation on outcomes of patients treated by transcatheter mitral valve repair

Cited by 6 publications

References 42 publications

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

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

The Onset of Atrial Fibrillation After Implantation of Mitraclip for Mitral Regurgitation: A Case Report

Incidence, etiology, and outcomes of pre- and post-operative atrial fibrillation in mitral valve procedures: a review

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