Prognostic value of pre-operative atrial fibrillation in patients with heart failure and secondary mitral regurgitation undergoing percutaneous mitral valve repair with MitraClip

Abstract

Abstract Background Limited data are available regarding the independent prognostic role of atrial fibrillation (AF) after transcatheter mitral valve repair with MitraClip. Aims We sought to evaluate the real impact of pre-operative AF in a wide series of patients with heart failure (HF) and secondary mitral regurgitation (MR) after MitraClip treatment. Methods The study included 605 patients with severe secondary MR from a multicenter international registry. Patients were stratified into two groups according to the presence or absence of pre-operative AF. The overall prevalence of pre-operative AF was 44%. Primary endpoint was 5-year overall death, secondary endpoints were 5–year cardiac death and first re-hospitalization for acute HF. Results At 5-year Kaplan-Meier (KM) analysis conducted in the entire study cohort, compared to patients without AF those with AF had significantly more adverse events in term of overall death (67% vs. 43%; p<0.001) (KM curve A) and cardiac death (65% vs. 37%; p=0.001) (KM curve B) and, moderately more re-hospitalization for acute HF (64% vs. 50%; p=0.048) (KM curve C). To account for baseline differences, patients were propensity score matched 1:1. After matching, 342 adequately matched patients were identified: compared to patients without AF, those with AF had higher rates of death and cardiac mortality but similar rates of re-hospitalization for acute HF. Conclusion In this large 5-year analysis of patients with HF undergoing MitraClip treatment for severe secondary MR, AF is common and associated with higher rates of both overall- and cardiac-death. However, AF doesn't seem to affect the benefit of the procedure in term of re-hospitalization for HF. Funding Acknowledgement Type of funding source: None