Catheter ablation of concomitant atrial fibrillation improves survival of patients undergoing transcatheter edge-to-edge mitral valve repair

Frontiers in Cardiovascular Medicine

Cardiovascular Medicine

Sebastian Kerber¹  Thomas Deneke¹  Sebastian Barth¹  Dieter Fischer²  Holger Nef³  Felix Ausbuettel⁴  Georgios Chatzis⁴  Dimitar Divchev⁴  Bernhard Schieffer⁴  Ulrich Luesebrink⁴  Christian Waechter⁴  Julian Mueller⁵  Philipp Halbfass⁶  Stephan List⁶  Hans-Helge Mueller⁷ 

[1] Department of Cardiology, Cardiovascular Center Bad Neustadt/Saale, Bad Neustadt an der Saale, Germany;Department of Cardiology, Cardiovascular Center Rotenburg/Fulda, Rotenburg an der Fulda, Germany;Department of Cardiology, Cardiovascular Center Rotenburg/Fulda, Rotenburg an der Fulda, Germany;Department of Cardiology, University Hospital Gießen, Justus Liebig University Gießen, Gießen, Germany;Department of Cardiology, University Hospital Marburg, Philipps University Marburg, Marburg, Germany;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;Department of Cardiology, University Hospital Oldenburg, Carl von Ossietzky University Oldenburg, Oldenburg, Germany;Institute for Bioinformatics and Biostatistics, Philipps University Marburg, Marburg, Germany;

关键词: pulmonary vein isolation;    atrial fibrillation;    mortality;    heart failure;    mitraclip;    PASCAL;    mitral regurgitation;    catheter ablation;   

DOI  :  10.3389/fcvm.2023.1229651

 received in 2023-05-26, accepted in 2023-07-28,  发布年份 2023

来源: Frontiers

【 摘 要 】

BackgroundAtrial 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.ObjectivesTo investigate the impact of treatment regimens for concomitant AF on survival of TEER patients.MethodsIn 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).ResultsA 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).ConclusionsCA 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.

【 授权许可】

Unknown   
© 2023 Ausbuettel, Barth, Chatzis, Fischer, Kerber, Mueller, List, Halbfass, Deneke, Nef, Mueller, Divchev, Schieffer, Luesebrink and Waechter.