Impact of transcatheter mitral valve repair on ventricular arrhythmias

Abstract

Aims Patients with heart failure and severe mitral regurgitation (MR) have a poor prognosis and carry an increased risk for ventricular arrhythmias. The present study evaluates the impact of transcatheter mitral valve repair using the MitraClip on the potential reduction of ventricular arrhythmias. Methods and results Patients undergoing MitraClip implantation were prospectively enrolled into the present study and received 24 h Holter ECG assessment prior to and 6 months after the procedure. In addition, left ventricular dimensions and function were assessed at baseline and follow-up. A total of 50 patients with mainly functional MR (82%) were included. Non-sustained or sustained ventricular tachycardia (nsVT and/or sVT) occurred in 32% of patients and was reduced to 14% at follow-up (P = 0.01). Also, premature ventricular complex (PVC) burden ≥5% decreased from 16% to 4% (P = 0.04). Patients with persistent (n = 6) or new (n = 1) nsVT and/or sVT at follow-up showed a significant decrease in left ventricular ejection fraction from 38% (interquartile range 26–45%) to 33% (interquartile range 22–44%; P = 0.03). Conclusions In this prospective study, transcatheter mitral valve repair using MitraClip was associated with a reduced prevalence of ventricular arrhythmias. The subset of patients with persistent or new ventricular arrhythmias after MitraClip implantation showed progression of left ventricular dysfunction.

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

“…A reduction in the incidence of VA and ICD therapies after successful PMVR were found in a small cohort of patients with HFrEF and FMR who had either a pacemaker, ICD or CRT implanted (9). Similarly, Ledwoch et al (10) documented by 24-hour electrocardiographic monitoring a reduction in ectopic ventricular activity, NSVT and SVT at 6-month follow-up after PMVR. Whether these changes have any impact on mortality, has not been evaluated.…”

“…Percutaneous mitral valve repair (PMVR) with MitraClip ® (Abbott Vascular, Santa Clara, USA) has proved to effectively reduce FMR in patients with HFrEF (8). Limited information has been reported regarding the impact of PMVR on VA burden (9,10). The aim of this study was to address the incidence of VA and appropriate antitachycardia pacing (ATP) and defibrillation shocks before and after PMVR in patients with HFrEF, FMR and implantable cardiac devices (ID).…”

Myxomatous Mitral Valve Disease with Mitral Valve Prolapse and Mitral Annular Disjunction: Clinical and Functional Significance of the Coincidence

“…Ledwoch et al [ 50 ] recently demonstrated in a prospective study using MitraClips in patients with heart failure and severe MR (82% had secondary MR) a significant reduction in ventricular arrhythmias (nsVT and sustained ventricular tachycardia (sVT)). They were reduced from 32% to 14% at follow-up ( p = 0.01), and the PVC decreased from 16% to 4% ( p = 0.04).…”

Management of implantable cardioverter-defibrillator patients with appropriate ICD shocks: A 3-step treatment concept

“…The application of the ToVAMI concept in the current ICD population was feasible and increased the rate of identified triggers and the rate of optimized heart failure treatment. This is mainly due to the recent development of new prognostic drugs or interventional therapies which offer new perspectives in the treatment of heart failure (3)(4)(5).…”

“…Prognostic heart failure treatment such as valsartan/sacubitril, CRT (cardiac resynchronization therapy) or Mitra-Clip are known to improve the survival of patients with heart failure while reducing the rate of sudden cardiac death and the occurrence of ventricular arrhythmias (3)(4)(5).…”