Background:

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.

Conclusions:

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.