Patients with heart failure and atrial fibrillation (AF) at the time of mitral transcatheter edge-to-edge repair (M-TEER) for severe mitral regurgitation (MR) are more than twice as likely to die or be rehospitalised for heart failure (HF), compared to patients without AF.
These are the findings of a study published in the Journal of the American Heart Association, suggesting that AF may have to be treated more aggressively before patients undergo this type of transcatheter procedure in order to improve outcomes.
“We found that even when the transcatheter mitral valve procedure is successful, having atrial fibrillation at the day of the procedure doubles the risk of death or rehospitalisation for heart failure. AF is a powerful risk marker that we need to take into consideration when planning and performing these procedures,” said corresponding author Stamatios Lerakis (Icahn School of Medicine at Mount Sinai, New York, USA). “We know that mitral regurgitation and AF are interconnected. The one begets more of the other and vice versa. This study suggests that rhythm control ahead of time may be critical for the outcome of patients undergoing these procedures.”
AF is found in up to one-third of patients with mitral regurgitation. Mount Sinai researchers wanted to better understand how M-TEER impacts outcomes of patients who have AF. They analysed 156 patients with symptomatic heart failure and severe mitral regurgitation treated with M-TEER at Mount Sinai Fuster Heart Hospital. All these patients were evaluated by the heart team before undergoing M-TEER.
The researchers divided patients into two groups: those with AF at the time of the procedure (38%), and those with no AF at the time of the procedure (62%). After the procedure, researchers tracked patient survival, heart failure hospitalisations, and heart structure/function changes using echocardiography over a median follow-up of more than a year.
M-TEER was equally successful in both groups (AF and no AF). However, those with AF fared worse in the months following: they were more likely to experience a return of valve leakage and their hearts didn’t recover as well.
More specifically, within two years following the procedure, more than 52% of AF patients were either rehospitalised for heart failure or had died, compared to 33% of patients with no AF. Their hearts didn’t recover as well—they showed no improvement in heart size and additionally, severe valve leakage returned in 19% of AF patients versus 8% of patients without AF.
“Previous research has shown conflicting results on M-TEER and AF patients—and while this is a single centre study from Mount Sinai Fuster Heart Hospital with a relatively small sample size, it still brings up an important problem,” stated author Carlo Mannina (Mount Sinai Morningside, New York, USA). “This definitely needs further investigation.”
“Our study emphasises the importance of atrial fibrillation as a major prognostic factor in patients with heart failure and severe mitral regurgitation, even after effective transcatheter edge-to-edge repair. These findings support early treatment of heart failure and mitral regurgitation before atrial fibrillation develops, in addition to considering ablation should atrial fibrillation occur,” added author Gregg W Stone (Icahn School of Medicine at Mount Sinai, New York, USA).
