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Ausbuettel F, Barth S, Chatzis G, Fischer D, Kerber S, Mueller J, List S, Halbfass P, Deneke T, Nef H, Mueller HH, Divchev D, Schieffer B, Luesebrink U, Waechter C. Catheter ablation of concomitant atrial fibrillation improves survival of patients undergoing transcatheter edge-to-edge mitral valve repair. Front Cardiovasc Med 2023; 10:1229651. [PMID: 37645518 PMCID: PMC10461005 DOI: 10.3389/fcvm.2023.1229651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/28/2023] [Indexed: 08/31/2023] Open
Abstract
Background Atrial fibrillation (AF) is the most common concomitant disease in patients undergoing transcatheter edge-to-edge repair (TEER) for mitral regurgitation (MR) and detrimentally affects their outcome. While there is increasing evidence for prognostic improvement and safety of catheter ablation (CA) of AF in the overall cohort of heart failure patients, corresponding data in TEER patients are lacking. Objectives To investigate the impact of treatment regimens for concomitant AF on survival of TEER patients. Methods In a multicenter observational cohort study consecutive patients successfully undergoing TEER were analyzed and survival of patients receiving CA of concomitant AF was compared with that of patients on pharmacological AF treatment and with that of patients without a history of AF, using propensity score matching (PSM). Results A total of 821 patients were analyzed. Of these, 608 (74.1%) had concomitant AF, of whom 48 patients received CA. Patients with CA in AF showed significantly higher 3-year-survival after TEER compared to PSM-patients on pharmacological AF treatment (75.5% [36/48] vs. 49.4% [166/336], p = 0.009). The 3-year-survival after TEER of patients with concomitant AF treated with CA was not significantly different from PSM-patients without AF (75.5% [36/48] vs. 68.3% [98/144], p = 0.36). Conclusions CA of AF is superior to pharmacotherapy as it significantly improves the survival of TEER patients in a PSM analysis. CA even offsets the prognostic disadvantage of coexisting AF in TEER patients. Given the growing evidence of prognostic benefits in the overall cohort of HF patients, our data point out the importance of treating concomitant AF and support CA as an essential part of a holistic management of TEER patients.
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Affiliation(s)
- Felix Ausbuettel
- Department of Cardiology, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
| | - Sebastian Barth
- Department of Cardiology, Cardiovascular Center Bad Neustadt/Saale, Bad Neustadt an der Saale, Germany
| | - Georgios Chatzis
- Department of Cardiology, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
| | - Dieter Fischer
- Department of Cardiology, Cardiovascular Center Rotenburg/Fulda, Rotenburg an der Fulda, Germany
| | - Sebastian Kerber
- Department of Cardiology, Cardiovascular Center Bad Neustadt/Saale, Bad Neustadt an der Saale, Germany
| | - Julian Mueller
- Department of Cardiology, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
- Department of Cardiology, Cardiovascular Center Bad Neustadt/Saale, Bad Neustadt an der Saale, Germany
| | - Stephan List
- Department of Cardiology, University Hospital Oldenburg, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Philipp Halbfass
- Department of Cardiology, University Hospital Oldenburg, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Thomas Deneke
- Department of Cardiology, Cardiovascular Center Bad Neustadt/Saale, Bad Neustadt an der Saale, Germany
| | - Holger Nef
- Department of Cardiology, Cardiovascular Center Rotenburg/Fulda, Rotenburg an der Fulda, Germany
- Department of Cardiology, University Hospital Gießen, Justus Liebig University Gießen, Gießen, Germany
| | - Hans-Helge Mueller
- Institute for Bioinformatics and Biostatistics, Philipps University Marburg, Marburg, Germany
| | - Dimitar Divchev
- Department of Cardiology, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
| | - Bernhard Schieffer
- Department of Cardiology, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
| | - Ulrich Luesebrink
- Department of Cardiology, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
| | - Christian Waechter
- Department of Cardiology, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
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Waechter C, Ausbuettel F, Chatzis G, Cheko J, Fischer D, Nef H, Barth S, Halbfass P, Deneke T, Mueller J, Kerber S, Divchev D, Schieffer B, Luesebrink U. Antithrombotic Treatment and Its Association with Outcome in a Multicenter Cohort of Transcatheter Edge-to-Edge Mitral Valve Repair Patients. J Cardiovasc Dev Dis 2022; 9:366. [PMID: 36354765 PMCID: PMC9695441 DOI: 10.3390/jcdd9110366] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/17/2022] [Accepted: 10/24/2022] [Indexed: 08/31/2023] Open
Abstract
Transcatheter edge-to-edge mitral valve repair (TEER) has become established as a safe and efficacious therapy for severe mitral regurgitation (MR) in high-risk patients. Despite its widespread use, postprocedural antithrombotic therapy (ATT) still to date is based on local expertise rather than evidence. In a multicenter, observational cohort study, 646 consecutive patients undergoing TEER were enrolled; 609 patients were successfully treated and antithrombotic therapy analyzed; 449 patients (73.7%) were previously treated with oral anticoagulants (OAC) due to the high prevalence of atrial fibrillation (459/609, 75.4%). Postprocedural ATT in patients previously treated with OAC consisted of no additional, additional single (SAPT) or dual antiplatelet therapy (DAPT) in 146/449 (33.6%), 248/449 (55.2%) and 55/449 (12.2%), respectively. There were 234/449 (52.1%) patients treated with vitamin-k antagonists (VKA) and 215/449 (47.9%) with nonvitamin-k antagonist oral anticoagulants (NOAC). One hundred sixty patients (26.3%) had no prior indication for OAC and were predominantly treated with DAPT (132/160, 82.5%). Use of SAPT (17/160, 10.6%) and no APT (11/160, 6.9%) was marginal. No statistically significant differences in terms of in-hospital mortality or the rate of major adverse cardiac and cerebrovascular events (MACCE) between the different antithrombotic therapy regimens were observed. Multiple Cox regression analysis showed a statistically significant decreased risk for all-cause mortality after a median follow-up of 419 days for OAC monotherapy (HR 0.6, 95%-CI 0.5-0.9, p = 0.04). This study provides evidence for a more favorable long-term outcome of OAC monotherapy in patients with an indication for OAC and reiterates the urgent need for randomized controlled trials on the optimal antithrombotic treatment of TEER patients.
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Affiliation(s)
- Christian Waechter
- Department of Cardiology, University Hospital Marburg, Baldingerstraße, 35043 Marburg, Germany
| | - Felix Ausbuettel
- Department of Cardiology, University Hospital Marburg, Baldingerstraße, 35043 Marburg, Germany
| | - Georgios Chatzis
- Department of Cardiology, University Hospital Marburg, Baldingerstraße, 35043 Marburg, Germany
| | - Juan Cheko
- Department of Cardiology, University Hospital Marburg, Baldingerstraße, 35043 Marburg, Germany
| | - Dieter Fischer
- Department of Cardiology, Cardiovascular Center Rotenburg/Fulda, Heinz-Meise-Straße 100, 36199 Rotenburg an der Fulda, Germany
| | - Holger Nef
- Department of Cardiology, Cardiovascular Center Rotenburg/Fulda, Heinz-Meise-Straße 100, 36199 Rotenburg an der Fulda, Germany
- Department of Cardiology, University Hospital Giessen, Klinikstraße 33, 35392 Giessen, Germany
| | - Sebastian Barth
- Department of Cardiology, Cardiovascular Center Bad Neustadt/Saale, Von-Guttenberg-Straße 11, 97616 Bad Neustadt an der Saale, Germany
| | - Philipp Halbfass
- Department of Cardiology, Cardiovascular Center Bad Neustadt/Saale, Von-Guttenberg-Straße 11, 97616 Bad Neustadt an der Saale, Germany
| | - Thomas Deneke
- Department of Cardiology, Cardiovascular Center Bad Neustadt/Saale, Von-Guttenberg-Straße 11, 97616 Bad Neustadt an der Saale, Germany
| | - Julian Mueller
- Department of Cardiology, University Hospital Marburg, Baldingerstraße, 35043 Marburg, Germany
- Department of Cardiology, Cardiovascular Center Bad Neustadt/Saale, Von-Guttenberg-Straße 11, 97616 Bad Neustadt an der Saale, Germany
| | - Sebastian Kerber
- Department of Cardiology, Cardiovascular Center Bad Neustadt/Saale, Von-Guttenberg-Straße 11, 97616 Bad Neustadt an der Saale, Germany
| | - Dimitar Divchev
- Department of Cardiology, University Hospital Marburg, Baldingerstraße, 35043 Marburg, Germany
| | - Bernhard Schieffer
- Department of Cardiology, University Hospital Marburg, Baldingerstraße, 35043 Marburg, Germany
| | - Ulrich Luesebrink
- Department of Cardiology, University Hospital Marburg, Baldingerstraße, 35043 Marburg, Germany
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Zhang J, Tan Q, Lina W, Zhaoqian Z. Endothelial dysfunction predicted cardiovascular events in patients with paroxysmal atrial fibrillation. Saudi Med J 2022; 43:708-714. [PMID: 35830994 PMCID: PMC9749696 DOI: 10.15537/smj.2022.43.7.20220214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 06/13/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To examine the relationship between endothelial dysfunction and adverse cardiovascular events in patients with paroxysmal atrial fibrillation (AF). METHODS In this prospective observational study, flow-mediated dilation (FMD) was measured by ultrasound in 291 patients with paroxysmal AF. Then, the patients were divided into low FMD group (n=97, FMD of <5.9%) or high FMD group (n=194, FMD of ≥5.9%). Patients were followed up for at least 30 months. Primary end point was cardiovascular events (stroke, heart failure hospitalization, cardiovascular death, and non-fatal myocardial infarction) and second endpoint was heart failure hospitalization, or stroke. RESULTS Rate of cardiovascular events was higher in low FMD group compared with high FMD group (37.1% versus 18%, p<0.001). This higher risk of cardiovascular events in patients with low FMD was primarily due to a higher risk of heart failure hospitalization compared with patients with high FMD (19.6% versus 10.8%, p<0.05). There was no significant difference of stroke between both groups. Cox proportional hazards ratio (HR) analysis showed that low FMD (HR: 3.036, 95% CI: [1.546-5.963], CHA2DS2-VASc scores (HR: 1.383, 95% CI: [1.035-1.847]), and left atrial diameter (HR: 1.304, 95% CI: [1.001-1.069]) were independent predictors for composite cardiovascular events. CONCLUSION In patients with paroxysmal AF, endothelial dysfunction was associated with composite cardiovascular events. Flow-mediated dilation was a significant predictor of cardiovascular events in patients with paroxysmal AF.
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Affiliation(s)
- Jing Zhang
- From the Department of Cardiology, Qinhuangdao First Hospital, Hebei Medical University, Qinhuangdao, China
| | - Qiang Tan
- From the Department of Cardiology, Qinhuangdao First Hospital, Hebei Medical University, Qinhuangdao, China
- Address correspondence and reprint request to: Dr. Qiang Tan, Department of Cardiology, Qinhuangdao First Hospital, Hebei Medical University, Qinhuangdao, China. E-mail: ORCID ID: https://orcid.org/0000-0003-1621-4428
| | - Wang Lina
- From the Department of Cardiology, Qinhuangdao First Hospital, Hebei Medical University, Qinhuangdao, China
| | - Zhang Zhaoqian
- From the Department of Cardiology, Qinhuangdao First Hospital, Hebei Medical University, Qinhuangdao, China
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Kubala M, de Chillou C, Bohbot Y, Lancellotti P, Enriquez-Sarano M, Tribouilloy C. Arrhythmias in Patients With Valvular Heart Disease: Gaps in Knowledge and the Way Forward. Front Cardiovasc Med 2022; 9:792559. [PMID: 35242822 PMCID: PMC8885812 DOI: 10.3389/fcvm.2022.792559] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 01/19/2022] [Indexed: 11/13/2022] Open
Abstract
The prevalence of both organic valvular heart disease (VHD) and cardiac arrhythmias is high in the general population, and their coexistence is common. Both VHD and arrhythmias in the elderly lead to an elevated risk of hospitalization and use of health services. However, the relationships of the two conditions is not fully understood and our understanding of their coexistence in terms of contemporary management and prognosis is still limited. VHD-induced left ventricular dysfunction/hypertrophy and left atrial dilation lead to both atrial and ventricular arrhythmias. On the other hand, arrhythmias can be considered as an independent condition resulting from a coexisting ischemic or non-ischemic substrate or idiopathic ectopy. Both atrial and ventricular VHD-induced arrhythmias may contribute to clinical worsening and be a turning point in the natural history of VHD. Symptoms developed in patients with VHD are not specific and may be attributable to hemodynamical consequences of valve disease but also to other cardiac conditions including arrhythmias which are notably prevalent in this population. The issue how to distinguish symptoms related to VHD from those related to atrial fibrillation (AF) during decision making process remains challenging. Moreover, AF is a traditional limit of echocardiography and an important source of errors in assessment of the severity of VHD. Despite recent progress in understanding the pathophysiology and prognosis of postoperative AF, many questions remain regarding its prevention and management. Furthermore, life-threatening ventricular arrhythmias can predispose patients with VHD to sudden cardiac death. Evidence for a putative link between arrhythmias and outcome in VHD is growing but available data on targeted therapies for VHD-related arrhythmias, including monitoring and catheter ablation, is scarce. Despite growing evidences, more research focused on the prognosis and optimal management of VHD-related arrhythmias is still required. We aimed to review the current evidence and identify gaps in knowledge about the prevalence, prognostic considerations, and treatment of atrial and ventricular arrhythmias in common subtypes of organic VHD.
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Affiliation(s)
- Maciej Kubala
- Department of Cardiology, Amiens University Hospital, Amiens, France
- Jules Verne University of Picardie, Amiens, France
| | - Christian de Chillou
- Department of Cardiology, University Hospital Nancy, Vandœuvre lès Nancy, France
| | - Yohann Bohbot
- Department of Cardiology, Amiens University Hospital, Amiens, France
- Jules Verne University of Picardie, Amiens, France
| | - Patrizio Lancellotti
- Department of Cardiology, GIGA Cardiovascular Sciences, University of Liège Hospital, Valvular Disease Clinic, CHU Sart Tilman, Liège, Belgium
| | - Maurice Enriquez-Sarano
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN, United States
| | - Christophe Tribouilloy
- Department of Cardiology, Amiens University Hospital, Amiens, France
- Jules Verne University of Picardie, Amiens, France
- *Correspondence: Christophe Tribouilloy
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Waechter C, Ausbuettel F, Chatzis G, Cheko J, Fischer D, Nef H, Barth S, Halbfass P, Deneke T, Kerber S, Kikec J, Mueller HH, Divchev D, Schieffer B, Luesebrink U. Impact of Rhythm vs. Rate Control in Atrial Fibrillation on the Long-Term Outcome of Patients Undergoing Transcatheter Edge-to-Edge Mitral Valve Repair. J Clin Med 2021; 10:5044. [PMID: 34768567 PMCID: PMC8584691 DOI: 10.3390/jcm10215044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/20/2021] [Accepted: 10/28/2021] [Indexed: 11/16/2022] Open
Abstract
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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Affiliation(s)
- Christian Waechter
- Department of Cardiology, University Hospital Marburg, Baldingerstraße, 35043 Marburg, Germany; (C.W.); (F.A.); (G.C.); (J.C.); (D.D.); (B.S.)
| | - Felix Ausbuettel
- Department of Cardiology, University Hospital Marburg, Baldingerstraße, 35043 Marburg, Germany; (C.W.); (F.A.); (G.C.); (J.C.); (D.D.); (B.S.)
| | - Georgios Chatzis
- Department of Cardiology, University Hospital Marburg, Baldingerstraße, 35043 Marburg, Germany; (C.W.); (F.A.); (G.C.); (J.C.); (D.D.); (B.S.)
| | - Juan Cheko
- Department of Cardiology, University Hospital Marburg, Baldingerstraße, 35043 Marburg, Germany; (C.W.); (F.A.); (G.C.); (J.C.); (D.D.); (B.S.)
| | - Dieter Fischer
- Department of Cardiology, Cardiovascular Center Rotenburg/Fulda, Heinz-Meise-Straße 100, 36199 Rotenburg/Fulda, Germany; (D.F.); (H.N.)
| | - Holger Nef
- Department of Cardiology, Cardiovascular Center Rotenburg/Fulda, Heinz-Meise-Straße 100, 36199 Rotenburg/Fulda, Germany; (D.F.); (H.N.)
- Department of Cardiology, University Hospital Giessen, Klinikstraße 33, 35392 Giessen, Germany
| | - Sebastian Barth
- Department of Cardiology, Cardiovascular Center Bad Neustadt/Saale, Von-Guttenberg-Straße 11, 97616 Bad Neustadt/Saale, Germany; (S.B.); (P.H.); (T.D.); (S.K.); (J.K.)
| | - Philipp Halbfass
- Department of Cardiology, Cardiovascular Center Bad Neustadt/Saale, Von-Guttenberg-Straße 11, 97616 Bad Neustadt/Saale, Germany; (S.B.); (P.H.); (T.D.); (S.K.); (J.K.)
| | - Thomas Deneke
- Department of Cardiology, Cardiovascular Center Bad Neustadt/Saale, Von-Guttenberg-Straße 11, 97616 Bad Neustadt/Saale, Germany; (S.B.); (P.H.); (T.D.); (S.K.); (J.K.)
| | - Sebastian Kerber
- Department of Cardiology, Cardiovascular Center Bad Neustadt/Saale, Von-Guttenberg-Straße 11, 97616 Bad Neustadt/Saale, Germany; (S.B.); (P.H.); (T.D.); (S.K.); (J.K.)
| | - Jan Kikec
- Department of Cardiology, Cardiovascular Center Bad Neustadt/Saale, Von-Guttenberg-Straße 11, 97616 Bad Neustadt/Saale, Germany; (S.B.); (P.H.); (T.D.); (S.K.); (J.K.)
| | - Hans-Helge Mueller
- Institute for Bioinformatics and Biostatistics, Philipps University, Bunsenstraße 3, 35037 Marburg, Germany;
| | - Dimitar Divchev
- Department of Cardiology, University Hospital Marburg, Baldingerstraße, 35043 Marburg, Germany; (C.W.); (F.A.); (G.C.); (J.C.); (D.D.); (B.S.)
| | - Bernhard Schieffer
- Department of Cardiology, University Hospital Marburg, Baldingerstraße, 35043 Marburg, Germany; (C.W.); (F.A.); (G.C.); (J.C.); (D.D.); (B.S.)
| | - Ulrich Luesebrink
- Department of Cardiology, University Hospital Marburg, Baldingerstraße, 35043 Marburg, Germany; (C.W.); (F.A.); (G.C.); (J.C.); (D.D.); (B.S.)
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