Clin Res Cardiol (2021). 10.1007/s00392-021-01933-9

Impact of Atrial fibrillation on survival after transcatheter edge-to-edge repair for mitral regurgitation
M. Geyer1, K. Keller1, S. Born1, K. Bachmann1, A. Tamm1, T. Ruf1, F. Kreidel1, M. Hell1, M. Ahoopai1, J. G. da Rocha e Silva1, T. Gößler1, E. Schulz2, T. Münzel1, R. S. von Bardeleben1
1Kardiologie 1, Zentrum für Kardiologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz; 2Klinik für Kardiologie, Allgemeines Krankenhaus Celle, Celle;


Symptomatic and prognostic improvement for transcatheter edge-to-edge repair (TEER) for mitral valve regurgitation (MR) has been proven. We aimed to evaluate a potential impact of pre-existing atrial fibrillation (AF) on all-cause mortality in a large monocentric cohort.

Methods and Results:

We retrospectively enrolled 627 patients (47.0% females, 57.4% functional etiology, survival status was available in 96.7%, median follow-up time 462 days [IQR 142/945]) undergoing isolated mitral valve TEER (combined forms of transcatheter therapy were excluded) treated between 6/2010 and 3/2018. While no differences were detected in most baseline parameters, patients with AF (representing 72.1% of the total cohort) were older (79.6 [74.9/84.3] vs. 78.2 [72.3/82.8] years, p=0.010), suffered more likely from arterial hypertension (87.8% vs. 80.6%, p=0.022) and  renal impairment (52.3% vs. 42.3%, p=0.026), had less often a functional pathomechanism of MR (FMR, 54.6% vs. 64.6%, p=0.025), higher grades of pre-interventional TR (severe TR 30.4% vs. 13.3%, p<0.001) and more often an impaired RV-function (TAPSE 16 [13/19] vs. 19 [15/22] mm, p=0.001). Nevertheless, no significant differences in short- and long-term survival were detected in AF-patients compared to those patients without AF (illustrated in the FIGURE, in-hospital mortality 2.7 vs. 1.7%, p=0.771; survival at 1 month 93.9% vs. 95.2%, p=0.693; at 1 year 74.2% vs.  73.4%, p=0.908; at 3 years 55.0% vs. 53.1%, p=0.883; 5 years 35.7% vs. 41.9%, p=0.655; 7 years 20.0% vs. 25.0%, p>0.99). Accordingly, AF was not associated with an increased mortality as calculated by cox regression analyses (1 year HR for mortality: 0.98 [95% CI 0.67-1.45], p=0.933; long-term HR 1.06 [95% CI 0.80-1.40], p=0.705). When stratified for underlying pathomechanism of MR (e. g. FMR: HR for mortality at 1 year: 1.03 [95% CI 0.63-1.68], p=0.902; long term HR 1.03 [95% CI 0.73-1.46], p=0.848) or for gender (e. g. HR for death of females with AF vs. males with AF: 1 year HR 1.09 [95% CI 0.71-1.66], p=0.696, long-term HR 0.79 [0.58-1.07], p=0.125), analogous observations regarding similar survival of patients with AF were made when compared to those without the comorbidity AF.


In this large monocentric cohort of patients undergoing TEER for MR with long follow-up up to 7 years, pre-interventional AF did not have a significant prognostic impact on short and long-term survival, even when stratifying for gender or underlying pathomechanism.