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

Felix Ausbuettel; Sebastian Barth; Georgios Chatzis; Dieter Fischer; Sebastian Kerber; Julian Mueller; Stephan List; Philipp Halbfass; Thomas Deneke; Holger Nef; Hans-Helge Mueller; Dimitar Divchev; Bernhard Schieffer; Ulrich Luesebrink; Christian Waechter

doi:10.3389/fcvm.2023.1229651

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

Front Cardiovasc Med. 2023 Aug 14:10:1229651. doi: 10.3389/fcvm.2023.1229651. eCollection 2023.

Authors

Felix Ausbuettel¹, Sebastian Barth², Georgios Chatzis¹, Dieter Fischer³, Sebastian Kerber², Julian Mueller^{1

2}, Stephan List⁴, Philipp Halbfass⁴, Thomas Deneke², Holger Nef^{3

5}, Hans-Helge Mueller⁶, Dimitar Divchev¹, Bernhard Schieffer¹, Ulrich Luesebrink¹, Christian Waechter¹

Affiliations

¹ Department of Cardiology, University Hospital Marburg, Philipps University Marburg, Marburg, Germany.
² Department of Cardiology, Cardiovascular Center Bad Neustadt/Saale, Bad Neustadt an der Saale, Germany.
³ Department of Cardiology, Cardiovascular Center Rotenburg/Fulda, Rotenburg an der Fulda, Germany.
⁴ Department of Cardiology, University Hospital Oldenburg, Carl von Ossietzky University Oldenburg, Oldenburg, Germany.
⁵ Department of Cardiology, University Hospital Gießen, Justus Liebig University Gießen, Gießen, Germany.
⁶ Institute for Bioinformatics and Biostatistics, Philipps University Marburg, Marburg, Germany.

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.

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

Grants and funding

The present work required no dedicated founding. CW was supported by the clinician scientist program (SUCCESS) of the Medical Faculty of the Philipps University Marburg, Germany. Open Access funding was provided by the Open Acess Publishing Fund of Philipps-Universität Marburg with support of the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation).