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Halboni A, Hamza M, Dayco J, Al-Abcha A, Alhalbouni A, Zghouzi M, Alhusain R, Sattar Y, Alraies MC. Outcomes of Transcatheter Mitral Valve Repair Using the MitraClip System in Patients With Atrial Fibrillation. A Meta-Analysis. Am J Cardiol 2024; 219:47-59. [PMID: 37865125 DOI: 10.1016/j.amjcard.2023.09.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 09/07/2023] [Accepted: 09/18/2023] [Indexed: 10/23/2023]
Abstract
Transcatheter mitral valve repair (TMVR) with the MitraClip system is now approved for degenerative and functional mitral regurgitation (MR). Atrial fibrillation (AF) is commonly seen in MR. In our study, we perform a pooled analysis of the existing data to investigate the outcomes of MitraClip in patients with versus without AF. We conducted a systematic search of PubMed, Google Scholar, and SCOPUS databases through December, 2022 for studies comparing the outcomes of TMVR using the MitraClip in patients with preexisting AF versus those without AF. A meta-analysis was performed to investigate the primary outcomes of all-cause mortality and heart failure (HF) hospitalization. Secondary outcomes were cardiovascular mortality, in-hospital mortality, stroke, New York Heart Association class I or II at follow-up, length of hospital stay, and procedural time. A total of 10 studies (n = 24,111; AF = 12,789; no AF = 11,322) were included in the final analysis. Preexisting AF was associated with higher overall all-cause mortality (odds ratio 1.55, 95% confidence interval 1.32 to 1.83, p <0.0002) and higher overall HF hospitalization rate (odds ratio 1.3, 95% confidence interval 1.08 to 1.56, p <0.0154). There was no statistically significant difference in cardiovascular mortality, in-hospital mortality, stroke, length of hospital stay, procedural time, or New York Heart Association class I/II at follow-up comparing AF versus no AF. The presence of AF in patients who underwent TMVR with MitraClip is associated with higher all-cause mortality and HF hospitalization. This should be taken into consideration in the management of MR patients.
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Affiliation(s)
- Adnan Halboni
- Department of Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, Michigan
| | - Mohammad Hamza
- Department of Medicine, Albany Medical Center, Albany, New York
| | - John Dayco
- Department of Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, Michigan
| | - Abdallah Al-Abcha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Mohamed Zghouzi
- Division of Vascular Medicine, University of Michigan, Ann Arbor, Michigan
| | - Rashid Alhusain
- Department of Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, Michigan
| | - Yasar Sattar
- Division of Cardiology, West Virginia University, Morgantown, West Virginia
| | - M Chadi Alraies
- Cardiovascular Institute, Detroit Medical Center, Detroit, Michigan.
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Dimitriadis K, Stathakopoulou C, Pyrpyris N, Beneki E, Adamopoulou E, Soulaidopoulos S, Leontsinis I, Kasiakogias A, Papanikolaou A, Tsioufis P, Aznaouridis K, Tsiachris D, Aggeli K, Tsioufis K. Interventional management of mitral regurgitation and sleep disordered breathing: "Catching two birds with one stone". Sleep Med 2024; 113:157-164. [PMID: 38029624 DOI: 10.1016/j.sleep.2023.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/09/2023] [Accepted: 11/11/2023] [Indexed: 12/01/2023]
Abstract
Sleep disordered breathing (SDB), mostly constituting of obstructive and central sleep apnea (OSA and CSA, respectively), is highly prevalent in the general population, and even more among patients with cardiovascular disease, heart failure (HF) and valvular heart disease, such as mitral regurgitation (MR). The coexistence of HF, MR and SDB is associated with worse cardiovascular outcomes and increased morbidity and mortality. Pulmonary congestion, as a result of MR, can exaggerate and worsen the clinical status and symptoms of SDB, while OSA and CSA, through various mechanisms that impair left ventricular dynamics, can promote left ventricular remodelling, mitral annulus dilatation and consequently MR. Regarding treatment, positive airway pressure devices used to ameliorate symptoms in SDB also seem to result in a reduction of MR severity, MR jet fraction and an improvement of left ventricular ejection fraction. However, surgical and transcatheter interventions for MR, and especially transcatheter edge to edge mitral valve repair (TEER), seem to also have a positive effect on SDB, by reducing OSA and CSA-related severity indexes and improving symptom control. The purpose of this review is to provide a comprehensive analysis of the common pathophysiology between SDB and MR, as well as to discuss the available evidence regarding the effect of SDB treatment on MR and the effect of mitral valve surgery or transcatheter repair on both OSA and CSA.
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Affiliation(s)
- Kyriakos Dimitriadis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece.
| | - Christina Stathakopoulou
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Nikolaos Pyrpyris
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Eirini Beneki
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Elena Adamopoulou
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Stergios Soulaidopoulos
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Ioannis Leontsinis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Alexandros Kasiakogias
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Aggelos Papanikolaou
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Panagiotis Tsioufis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Konstantinos Aznaouridis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Dimitris Tsiachris
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Konstantina Aggeli
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Konstantinos Tsioufis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
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Zhou C, Tan K, Liu W, Li S, Xia Z, Song Y, Lian Z. Temporal Trends and Early Outcomes of Transcatheter versus Surgical Mitral Valve Repair in Atrial Fibrillation Patients. J Interv Cardiol 2023; 2023:4332684. [PMID: 37868768 PMCID: PMC10586899 DOI: 10.1155/2023/4332684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 08/21/2023] [Accepted: 10/03/2023] [Indexed: 10/24/2023] Open
Abstract
Objectives To study trends of utilization, in-hospital outcomes, and short outcomes in patients undergoing transcatheter mitral valve repair (TMVR) vs. surgical mitral valve repair (SMVR) in atrial fibrillation (AF). Background TMVR is a treatment option in inoperable or high-risk patients with mitral regurgitation (MR). AF is a common comorbidity of MR. Data comparing between TMVR and SMVR in MR patients with AF is lacking. Methods The National Readmission Database from 2016 to 2019 was utilized to identify hospitalizations undergoing TMVR or SMVR with AF. Outcomes of interest included mortality, postoperative complications, length of stay, and 30-day readmission rate. Results A total of 9,195 patients underwent TMVR and 16,972 patients underwent SMVR with AF; the number of AF undergoing TMVR was increasing from 1,342 in 2016 to 4,215 in 2019 and SMVR. The incidence of in-hospital mortality decreased from 2.6% in 2016 to 1.8% in 2019. We identified length of stay>5 days, dyslipidemia, cerebrovascular disease, heart failure with reduced ejection fraction, and urgent/emergent admissions as independent risk factors for in-hospital mortality. After matching, we included 4,680 patients in each group; the in-hospital death, transfusion, acute kidney injury, sepsis, stroke, and mechanical ventilation were lower in TMVR compared with SMVR. TMVR was associated with a similar rate of all-cause readmission at 30 days compared with SMVR. Conclusion Patients with AF receiving TMVR have been increasing along with progressive improvement in in-hospital death and length of stay. Compared to SMVR, AF patients receiving TMVR had a lower rate of in-hospital death and postoperative complications.
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Affiliation(s)
- Chi Zhou
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Kai Tan
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Weili Liu
- Interventional Operation Room, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Shaohua Li
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zongyi Xia
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yanxu Song
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zhexun Lian
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, China
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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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Lima FV, Berkowitz J, Kennedy KF, Kolte D, Saad M, Elmariah S, Palacios IF, Inglessis I, Khera S, Assa EB, Gordon P, Chu AF. Incidence and Predictors of New-Onset Atrial Fibrillation After Transcatheter Edge-to-Edge Repair of the Mitral Valve (from the Nationwide Readmissions Database). Am J Cardiol 2022; 182:55-62. [PMID: 36075754 DOI: 10.1016/j.amjcard.2022.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 07/17/2022] [Accepted: 07/18/2022] [Indexed: 11/29/2022]
Abstract
Patients who underwent transcatheter edge-to-edge repair (TEER) for mitral regurgitation with atrial fibrillation (AF) at baseline have higher mortality than those without AF. Data on new-onset AF (NOAF) after TEER are limited. Using the 2016 to 2018 Nationwide Readmissions Database, we identified a cohort of patients who underwent TEER and classified them into 3 groups based on AF presence during the study period. The primary end point was the incidence and timing of NOAF up to 6 months after TEER. Logistic regression modeling identified independent predictors of NOAF at readmission. Of the 6,861patients that underwent TEER, 4,134 (59.9%) had AF at baseline, and 239 (3.5%) developed NOAF. Median time-to-NOAF admission was 47 days (interquartile range 16 to 113), and 37% of patients with NOAF presented within 30 days after TEER. Patients with NOAF experienced costlier and longer index-TEER hospitalization and had more co-morbidities. Chronic kidney disease (odds ratio [OR] 1.51, 95% confidence interval [CI] 1.03 to 2.20), fluid and electrolyte disorders (OR 1.59, 95% CI 1.01 to 2.52), and heart failure (OR 1.86, 95% CI 1.01 to 3.44) were identified as independent predictors of NOAF. Hypertensive complications and heart failure were the leading causes of readmission. In conclusion, those patients that developed NOAF after TEER tended to be an overall sicker group at baseline compared with the remainder of the study cohort. These data, obtained from a nationally representative cohort, highlight a particular group of patients subject to developing NOAF and their association with increased rehospitalization in the post-TEER setting. Predictors of NOAF can be screened for during TEER workup to identify patients at increased risk.
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Affiliation(s)
- Fabio V Lima
- Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, Rhode Island.
| | - Julia Berkowitz
- Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | | | - Dhaval Kolte
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Marwan Saad
- Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Sammy Elmariah
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Igor F Palacios
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ignacio Inglessis
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sahil Khera
- Division of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Eyal Ben Assa
- Structural Heart Disease Program, Assuta Ashdod Medical Center and The Ben-Gurion University of the Negev, Ashdod, Israel; Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Paul Gordon
- Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Antony F Chu
- Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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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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8
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Kaur S, Sadana D, Patel J, Gad M, Sankaramangalam K, Krishnaswamy A, Miyasaka R, Harb SC, Kapadia SR. Atrial Fibrillation and Transcatheter Repair of Functional Mitral Regurgitation: Evidence From a Meta-Regression. JACC Cardiovasc Interv 2021; 13:2374-2384. [PMID: 33092711 DOI: 10.1016/j.jcin.2020.06.050] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/15/2020] [Accepted: 06/23/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The aim of this study was to assess the impact of atrial fibrillation (AF) on mortality and efficacy in patients with functional mitral regurgitation (FMR) undergoing MitraClip implantation. BACKGROUND AF is a common arrhythmia in patients with severe FMR undergoing transcatheter mitral valve repair with the MitraClip device. Although AF has been consistently shown to be associated with poor outcomes after mitral valve surgery, the impact of AF on outcomes of MitraClip placement in patients with FMR has not been well studied. METHODS Prospective, retrospective registries, observational studies, and randomized controlled trials on MitraClip reporting AF and FMR as one of the variables from inception until January 2019 were included. RESULTS Of the initial 1,694 studies, 15 studies met the inclusion criteria. From a total of 5,184 patients, 2,105 patients were identified to have FMR and AF. All-cause 30-day mortality in patients with FMR was 3.7% (95% confidence interval: 2.87 to 4.66) and 1-year mortality was 17.9% (95% confidence interval: 16.01 to 19.71). The meta-regression analysis studying the impact of AF among patients with FMR treated with the MitraClip demonstrated no difference in mortality at 30 days but demonstrated significantly increased mortality at 1 year (95% confidence interval: 0.0006 to 0.0027) (p = 0.004). AF did not influence procedural success. CONCLUSIONS This meta-regression identifies AF as an independent negative predictor of long-term mortality after MitraClip implantation in patients with FMR. The mechanism of worse outcomes in patients with AF requires further study.
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Affiliation(s)
- Simrat Kaur
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Divyajot Sadana
- Department of Pulmonary and Critical Care, Cleveland Clinic, Cleveland, Ohio
| | - Jay Patel
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Mohamed Gad
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Kesavan Sankaramangalam
- Department of Internal Medicine, Saint Peter's University Hospital/Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Amar Krishnaswamy
- Department of Interventional Cardiology, Cleveland Clinic, Cleveland, Ohio
| | - Rhonda Miyasaka
- Department of Cardiovascular Imaging, Cleveland Clinic, Cleveland, Ohio
| | - Serge C Harb
- Department of Cardiovascular Imaging, Cleveland Clinic, Cleveland, Ohio
| | - Samir R Kapadia
- Department of Interventional Cardiology, Cleveland Clinic, Cleveland, Ohio.
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9
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Godino C, Sisinni A, Pivato CA, Adamo M, Taramasso M, Parlati A, Italia L, Voci D, Scotti A, Munafò A, Buzzatti N, Denti P, Ancona F, Fiore G, Sala A, Vergara P, Bodega F, Ruffo MM, Curello S, Castiglioni A, De Bonis M, Alfieri O, Agricola E, Maisano F, Metra M, Colombo A, Margonato A. Prognostic Value of Pre-operative Atrial Fibrillation in Patients With Secondary Mitral Regurgitation Undergoing MitraClip Implantation. Am J Cardiol 2021; 143:51-59. [PMID: 33359201 DOI: 10.1016/j.amjcard.2020.12.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/06/2020] [Accepted: 12/08/2020] [Indexed: 12/30/2022]
Abstract
Limited data are available regarding the independent prognostic role of preoperative atrial fibrillation (AF) after transcatheter mitral valve repair with MitraClip. We sought to evaluate the impact of preoperative AF in patients with heart failure (HF) and concomitant secondary mitral regurgitation (MR) after MitraClip treatment. The study included 605 patients with significant secondary MR from a multicenter international registry. Patients were stratified into 2 groups according to the presence or absence of preoperative AF. Primary end point was 5-year overall death, secondary end points were 5-year cardiac death and first re-hospitalization for HF. To account for baseline differences, patients were propensity score matched 1:1. The overall prevalence of preoperative AF was 44%. At 5-year Kaplan-Meier analysis, compared with patients without AF, those with AF had significantly more adverse events in term of overall death (67% vs 43%; HR 1.84, log-rank p <0.001) and cardiac death (56% vs 29%; HR 2.11, log-rank p <0.001) and re-hospitalization for HF (63% vs 52%; HR 1.33, log-rank p = 0.048). Multivariate analysis identified AF as independent predictor of worse outcome in term of primary end point (HR 1.729, 95% C.I. 1.060 to 2.821; p = 0.028). After propensity score matching, patients with AF had higher rates of death and cardiac mortality but similar rates of re-hospitalization for HF. In conclusion, in patients with HF undergoing MitraClip treatment for secondary MR, preoperative AF is common and an unfavourable predictor of 5-year death and cardiac death. However, AF did not affect the frequency of re-hospitalization for HF.
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Affiliation(s)
- Cosmo Godino
- Cardiovascular Department, San Raffaele Scientific Institute, Milan, Italy..
| | - Antonio Sisinni
- Cardiovascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Carlo Andrea Pivato
- Humanitas Clinical and Research Center IRCCS - Rozzano, Milan, Italy.; Department of Biomedical Sciences - Pieve Emanuele, Humanitas University, Milan, Italy
| | - Marianna Adamo
- Cardiac Catheterization Laboratory, Cardiothoracic Department, Spedali Civili, Brescia, Italy
| | | | - Antonio Parlati
- Cardiovascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Leonardo Italia
- Cardiac Catheterization Laboratory, Cardiothoracic Department, Spedali Civili, Brescia, Italy
| | - Davide Voci
- Division of Cardiac Surgery, University Hospital Zürich, Switzerland
| | - Andrea Scotti
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua Medical School, Padua, Italy
| | - Andrea Munafò
- Cardiovascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Buzzatti
- Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Denti
- Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Ancona
- Cardiovascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Giorgio Fiore
- Cardiovascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Alessandra Sala
- Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Pasquale Vergara
- Arrhythmias and Cardiac Electrophysiology, Ospedale San Raffaele, Milan, Italy
| | - Francesca Bodega
- Cardiovascular Department, San Raffaele Scientific Institute, Milan, Italy
| | | | - Salvatore Curello
- Cardiac Catheterization Laboratory, Cardiothoracic Department, Spedali Civili, Brescia, Italy
| | | | - Michele De Bonis
- Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Ottavio Alfieri
- Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Eustachio Agricola
- Cardiovascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Maisano
- Division of Cardiac Surgery, University Hospital Zürich, Switzerland
| | - Marco Metra
- Cardiology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University, Cardiothoracic Department, Spedali Civili of Brescia, Brescia, Italy
| | - Antonio Colombo
- Cardiology Unit, GVM Care & Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Alberto Margonato
- Cardiovascular Department, San Raffaele Scientific Institute, Milan, Italy
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10
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Shah S, Raj V, Abdelghany M, Mena-Hurtado C, Riaz S, Patel S, Wiener H, Chaudhuri D. Impact of atrial fibrillation on the outcomes of transcatheter mitral valve repair using MitraClip: a systematic review and meta-analysis. Heart Fail Rev 2020; 26:531-543. [PMID: 33169339 DOI: 10.1007/s10741-020-10051-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2020] [Indexed: 12/29/2022]
Abstract
Atrial fibrillation (AF) is a common arrhythmia in patients with mitral regurgitation (MR) undergoing transcatheter mitral valve repair (TMVR). In this systematic review, we aimed to investigate the outcomes of TMVR using MitraClip in AF patients. We performed a systematic search using PubMed, SCOPUS, EMBASE, and Google Scholar, from inception to May 10, 2020, for studies that reported outcomes following MitraClip, in patients with AF versus without AF. Seven studies with a total of 7678 patients met the inclusion criteria. The risk of 1-year all-cause mortality following TMVR was higher in AF patients (RR 1.40, 95% CI 1.27-1.54, p ≤ 0.001). Similarly, the risk of heart failure hospitalization was higher in patients with AF (RR 1.17, 95% CI 1.06-1.30, p = 0.002) and the risk of bleeding was elevated in AF patients (RR 1.29, 95% CI 1.15-1.45, p ≤ 0.001). The risk of procedural failure, in-hospital mortality, cardiovascular mortality, and stroke was not significantly different between the two groups. The higher risk of all-cause mortality, HF hospitalization, and risk of bleeding in AF patients undergoing MitraClip warrants attention.
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Affiliation(s)
- Siddharth Shah
- Department of Medicine, Division of Cardiology, State University of New York Upstate Medical University, 750 E Adams Street, Syracuse, NY, 13210, USA.
| | - Vijay Raj
- Department of Medicine, Division of Cardiology, State University of New York Upstate Medical University, 750 E Adams Street, Syracuse, NY, 13210, USA
| | - Mahmoud Abdelghany
- Pioneer Valley Cardiology, University of Massachusetts/ Baystate Medical Center, Mercy Medical Center, Springfield, MA, USA
| | - Carlos Mena-Hurtado
- Department of Medicine, Division of Cardiology, Yale University School of Medicine, New Haven, CT, USA
| | - Sana Riaz
- Department of Medicine, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Siddharth Patel
- Department of Pulmonary, Allergy and Critical care, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Howard Wiener
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| | - Debanik Chaudhuri
- Department of Medicine, Division of Cardiology, State University of New York Upstate Medical University, 750 E Adams Street, Syracuse, NY, 13210, USA
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11
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Sun F, Liu H, Zhang Q, Lu F, Zhan H, Zhou J. Impact of atrial fibrillation on outcomes of patients treated by transcatheter mitral valve repair: A systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e22195. [PMID: 33019394 PMCID: PMC7535682 DOI: 10.1097/md.0000000000022195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Conflicting data have been reported related to the impact of atrial fibrillation (AF) on outcomes after transcatheter mitral valve repair with MitraClip (MC) implantation. In this study, we assessed the prognosis of MC-treated patients according to the presence of pre-existing AF. METHODS Randomized and observational studies reporting outcomes of pre-existing AF or sinus rhythm in patients undergoing MC treatment were identified with an electronic search. Outcomes of interest were short-and long-term mortality, stroke, bleeding, rehospitalization, myocardial infarction (MI), cardiogenic shock, acute procedure success, the hospital stay, and the number of Clips implanted. RESULTS Eight studies (8466 individuals) were eligible. Compared to sinus rhythm, long-term mortality, the risk of bleeding, rehospitalization, and longer hospital stay were significantly higher in AF groups, whereas similar correlations were found in the analysis of other outcomes. CONCLUSION AF may be related with worse outcomes in patients undergoing MC implantation, including long-term mortality, major bleeding, and rehospitalization. AF should be taken into account when referring a patient for MC treatment.
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Affiliation(s)
| | | | - Qi Zhang
- Department of Endovascular Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Fanfan Lu
- Department of Cardiovascular Surgery
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12
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Lee CW, Frerker C, Huang WM, Tsai YL, Huang CJ, Yu WC, Hsu CP, Chiang CE, Chen CH, Sung SH. Feasibility and rationale of direct current cardioversion immediately after transcatheter percutaneous edge-to-edge mitral valve repair. Eur J Clin Invest 2020; 50:e13274. [PMID: 32762079 DOI: 10.1111/eci.13274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 05/03/2020] [Accepted: 05/09/2020] [Indexed: 11/27/2022]
Abstract
AIMS Atrial fibrillation (AF) is a frequent comorbidity among patients with severe mitral regurgitation (MR). Direct current (DC) cardioversion is one of the strategies for rhythm control. However, the safety and feasibility of immediate DC cardioversion after MitraClip are not elucidated. METHODS AND RESULTS In this study, patients with symptomatic severe MR who underwent MitraClip were included. After fixing the MR, synchronized DC cardioversion was attempted for those with AF. A total of consecutive 60 patients, 36 subjects (60%), comorbid with AF. DC cardioversion was performed in 30 patients (mean age of 76.0 ± 9.3 years), and the successful conversion was achieved in 15 patients (50%). There was no any adverse event related to the cardioversion. Subjects with sustained conversion to SR experienced significant improvement in 6MWT (failed: 285 ± 110-308 ± 135 m, P = .278; successful: 269 ± 109 m-328 ± 78, P = .047) and reduction in NT-proBNP level (failed: 4411 ± 7401-3296 ± 4299 ng/mL, P = .217; successful: 4094 ± 2735-2353 ± 2856 ng/mL, P = .026) at 1 month. CONCLUSIONS Direct current cardioversion seemed to be safe and feasible immediately after the transcatheter edge-to-edge mitral valve repairs. Subjects who maintain SR experienced better functional improvement.
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Affiliation(s)
- Ching-Wei Lee
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Christian Frerker
- Heart Center, Department of Internal Medicine III, University of Cologne, Cologne, Germany
| | - Wei-Ming Huang
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Lin Tsai
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chi-Jung Huang
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wen-Chung Yu
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University, Taipei, Taiwan.,Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Chiao-Po Hsu
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan.,Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chern-En Chiang
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan.,Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,General Clinical Research Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chen-Huan Chen
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan.,Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Hsien Sung
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,General Clinical Research Center, Taipei Veterans General Hospital, Taipei, Taiwan
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13
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Analysis of Atrial Fibrillation Treatment Regimes in a Multicenter Cohort of Transcatheter Edge-to-Edge Mitral Valve Repair Patients. J Interv Cardiol 2020; 2020:6542028. [PMID: 32934608 PMCID: PMC7474750 DOI: 10.1155/2020/6542028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/22/2020] [Accepted: 08/18/2020] [Indexed: 11/23/2022] Open
Abstract
Background Atrial fibrillation (AF) is a highly prevalent comorbidity in patients with severe mitral valve regurgitation (MR). Recent studies show a deleterious outcome of patients with concomitant AF after transcatheter mitral valve repair (TMVR). This underlines the essential need for additional strategies that ameliorate the prognosis of these patients. Fundamental data on AF characteristics and treatment regimes in this special cohort of patients are lacking. Methods We retrospectively analyzed the data of 542 consecutive patients with severe MR undergoing TMVR in three tertiary heart centers with special focus on AF type and underlying treatment strategies. Results The prevalence of concomitant AF was 73.3%, and AF did not affect the procedural success or the incidence of major adverse cardiac and cerebrovascular events. The patients with AF were more frequently >75 years, had more tricuspid regurgitation, and less coronary artery disease than non-AF patients. The distribution of AF types was 32% paroxysmal AF, 27% persistent AF, and 41% permanent AF. Except for a higher degree in severe tricuspid regurgitation and a higher likelihood of male sex, no substantial differences were observed while comparing permanent and nonpermanent AF patients. The predominant treatment regime was rate control (57%), with only beta blockers (BB) in the majority of persistent and permanent AF patients, while additional digitalis or a pacemaker was used infrequently. Rhythm control was mainly achieved with BB alone in paroxysmal AF patients and with additional antiarrhythmic drugs in the majority of persistent AF patients. Interventional rhythm control therapy was performed in 2.5% and 30.9% of paroxysmal and persistent AF patients, respectively. The guideline-adherent use of oral anticoagulants was comparable and high in both groups (91.9% in nonpermanent vs. 90.1% in permanent AF). Conclusion This is the first study to provide necessary information for the understanding of the current clinical practice in dealing with TMVR patients. Since evidence suggests that AF is not a benign concomitant disease, further investigations are needed to assess the prognostic impact of these different AF treatment strategies.
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14
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Shatila W, Krajcer Z. Myocardial fibrosis and MitraClip: Does it even matter? Catheter Cardiovasc Interv 2019; 93:1150-1151. [DOI: 10.1002/ccd.28311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 04/14/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Wassim Shatila
- Department of CardiologyTexas Heart Institute Houston Texas
- Division of CardiologyDepartment of Medicine, Baylor College of Medicine Houston Texas
| | - Zvonimir Krajcer
- Department of CardiologyTexas Heart Institute Houston Texas
- Division of CardiologyDepartment of Medicine, Baylor College of Medicine Houston Texas
- Department of Cardiology, CHI St. Luke's Health—Baylor St. Luke's Medical Center Houston Texas
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