Heart Failure And Atrial Fibrillation At The Time Of Mitral Valve Repair Linked To Worse Outcomes

Patients pinch bosom nonaccomplishment and atrial fibrillation (AF) astatine nan clip of mitral transcatheter edge-to-edge repair (M-TEER) for terrible mitral regurgitation are much than doubly arsenic apt to dice aliases beryllium rehospitalized for bosom failure, compared to patients without AF. These are nan findings from a Mount Sinai Fuster Heart Hospital study that links nan beingness of AF astatine nan clip of nan process to worse outcomes pursuing nan procedure.

The results, published July 17 successful nan Journal of nan American Heart Association, propose that AF whitethorn person to beryllium treated much aggressively earlier patients acquisition this type of transcatheter process successful bid to amended outcomes.

We recovered that moreover erstwhile nan transcatheter mitral valve process is successful, having atrial fibrillation astatine nan time of nan process doubles nan consequence of decease aliases rehospitalization for bosom failure. AF is simply a powerful consequence marker that we request to return into information erstwhile readying and performing these procedures. We cognize that mitral regurgitation and AF are interconnected. The 1 begets much of nan different and vice versa. This study suggests that hit power up of clip whitethorn beryllium captious for nan result of patients undergoing these procedures."

Stamatios Lerakis, MD, PhD, Corresponding Author, Professor of Medicine (Cardiology), Icahn School of Medicine astatine Mount Sinai

"Our study emphasizes nan value of atrial fibrillation arsenic a awesome prognostic facet successful patients pinch bosom nonaccomplishment and terrible mitral regurgitation, moreover aft effective transcatheter edge-to-edge repair. These findings support early curen of bosom nonaccomplishment and mitral regurgitation earlier atrial fibrillation develops, successful summation to considering ablation should atrial fibrillation occur," says writer Gregg W. Stone, MD, Professor of Medicine (Cardiology) astatine nan Icahn School of Medicine astatine Mount Sinai.

Mitral regurgitation is nan 2nd astir communal valvular disease, affecting much than 2 cardinal adults successful nan United States. It develops erstwhile nan mitral valve, which controls nan travel of humor from nan near atrium into nan near ventricle, becomes distorted from nan enlarged near ventricle truthful that its leaflets do not wholly close. This causes humor to leak backward, increases unit successful nan heart, and puts patients astatine accrued consequence of hospitalization and death. In astir patients, this information tin beryllium treated pinch a minimally invasive process called M-TEER successful which nan leaflets of nan mitral valve are clipped together.

Atrial fibrillation-a accelerated and irregular heartbeat-is recovered successful up to one-third of patients pinch mitral regurgitation. Mount Sinai researchers wanted to amended understand really M-TEER impacts outcomes of patients who person AF. They analyzed 156 patients pinch symptomatic bosom nonaccomplishment and terrible mitral regurgitation treated pinch M-TEER astatine Mount Sinai Fuster Heart Hospital. All these patients were evaluated by nan bosom squad earlier undergoing M-TEER.

The researchers divided patients into 2 groups: those pinch AF astatine nan clip of nan process (38 percent), and those pinch nary AF astatine nan clip of nan process (62 percent). After nan procedure, researchers tracked diligent survival, bosom nonaccomplishment hospitalizations, and bosom structure/function changes utilizing echocardiography complete a median follow-up of much than a year.

M-TEER was arsenic successful successful some groups (AF and nary AF). However, those pinch AF fared worse successful nan months following: they were much apt to acquisition a return of valve leakage and their hearts didn't retrieve arsenic well.

More specifically, wrong 2 years pursuing nan procedure, much than 52 percent of AF patients were either rehospitalized for bosom nonaccomplishment aliases had died, compared to 33 percent of patients pinch nary AF. Their hearts didn't retrieve arsenic well-they showed nary betterment successful bosom size and additionally, terrible valve leakage returned successful 19 percent of AF patients versus 8 percent of patients without AF. 

"Previous investigation has shown conflicting results connected M-TEER and AF patients-and while this is simply a azygous halfway study from Mount Sinai Fuster Heart Hospital pinch a comparatively mini sample size, it still brings up an important problem," says writer Carlo Mannina, MD, a cardiology chap astatine Mount Sinai Morningside. "This decidedly needs further investigation."