History of Paroxysmal, Persistent, Long-Standing or Permanent Atrial Fibrillation in Patients Undergoing Transcatheter Mitral Valve Repair with Mitraclip: Does it Matter?

Abstract

Background: Atrial Fibrillation (AF) may impact adversely on mitral valve function. Transcatheter Mitral Valve Repair (TMVR) with MitraClip is considered an acceptable alternative to surgical repair in high risk patients, and the EVEREST II trial has suggested that this holds true even in patients with AF. However, there is uncertainty on the outlook of real-world patients with AF undergoing TMVR. Methods: We analyzed retrospectively collected data on patients undergoing TMVR at 3 tertiary care centers. Baseline, procedural, and outcome details were systematically sought. Patients were followed after discharge for clinical events and echocardiographic changes. Results: A total of 116 subjects were included: 61 (53%) with AF and 55 (47%) without AF. Patients with AF had worse baseline functional class and EuroSCORE II, and a higher prevalence of type II mitral regurgitation, but patients without AF had higher prevalence of dilated or ischemic cardiomyopathy and of severe mitral regurgitation (all p < 0.05). Procedural success was achieved in most patients (115 [99%]) with out any differences according to the history of AF, but multiple MitraClips were required more frequently in patients with AF (p = 0.031). Echocardiographic and clinical results at follow-up were also similarly favorable, with 4 (3%) in-hospital deaths and a total of 15 (13%) at follow-up. However, patients with AF had a higher incidence of the composite of death or rehospitalizations for heart failure (14 [34%] vs 5 [13%], p = 0.035). Differences were not especially pronounced when focusing on patients with longstanding/ permanent AF vs those with paroxysmal/persistent AF. Conclusions: Despite largely similar baseline, echocardiographic and procedural features, patients with AF undergoing TMVR with MitraClip may face a higher risk of adverse events during follow-up. Careful follow-up and medical management are thus mandatory in such patients, irrespective of the subtype of AF.