An under-recognized high-risk atrial fibrillation population: Analyzing transcatheter mitral valve repair patients for left atrial appendage closure device application.

Abstract

Identify patients undergoing transcatheter mitral valve repair (TMVR) who could potentially benefit from alternative ischemic stroke prophylaxis utilizing a left atrial appendage closure (LAAC) device. Patients undergoing TMVR have a high incidence of atrial fibrillation (AF). The co-morbidities which qualify them to undergo TMVR also increase their risk of stroke and bleeding, making stroke prophylaxis problematic. We conducted a single-center retrospective study, in which the bleeding and stroke risk of all patients undergoing TMVR for degenerative mitral valve disease were reviewed to determine candidacy for a LAAC device for stroke prevention as an alternative to chronic anticoagulation. AF was present in 122 (62%) of TMVR patients with an average CHA2DS2-VASc score of 3.99. 23% of TMVR patients had a history of prior major bleeding event, predominately gastrointestinal bleed. Fifty-three and 47% of TMVR patients were at high or intermediate risk of bleeding, respectively, according to their HAS-BLED score. 50% of patients undergoing TMVR would qualify for LAAC device based on risk assessments. Patients undergoing TMVR represent a high risk group of AF patients that may benefit from a LAAC device.