Background Atrial fibrillation (AF) is common in patients with severe mitral regurgitation (MR) undergoing percutaneous mitral valve repair (PMVR). Data on AF ablation in post-PMVR patients is still sparse but of eminent importance. In this study, we assessed the feasibility, safety and clinical outcome of AF Ablation in post-PMVR patients.

Methods 426 patients with PMVR for severe MR were included in the COburg MItraclip (COMI) registry between 2016 and 2021. Out of them 284 (67%) patients experienced AF. We enrolled all patients who underwent an AF ablation including pulmonary vein isolation (PVI) and/or substrate ablation after PMVR and assessed the clinical characteristics and outcome after a mean follow-up of 17 ± 15 months.

Results Ten patients (7/10 female with a mean age of 72 ± 5 years) underwent AF ablation. All patients had a dyspnea NYHA II-III with 7/10 patients having a reduced ejection fraction (EF). The MR was secondary in 6 and primary in 4 patients. The PMVR was successful in all patients. Compared to the non-ablation group, ablated patients were younger (p=0.012) and had less renal insufficiency (p=0.04). Other clinical characteristics were comparable between ablation and non-ablation groups. 

Indication for ablation was paroxysmal AF in 5 and persistent AF in 5 patients. Mean AF history was 52 ± 37 months. The time between PMVR and AF ablation was 9.6 ± 10.7 months. Left atrial mapping showed low voltage area in 7/10 patients. In 4 patients ablation of atrial tachycardias occurring during the procedure was performed. Linear lesions were necessary in 6 patients. The mean procedure time was 156 ± 43 minutes, mean fluoroscopy duration 10 ± 5 minutes and radiofrequency duration 27 ± 15 minutes. No major complications except one pseudoaneurysm. AF/AT recurrence at follow-up was observed in 5/10 patients and 3 patients underwent reablation. Patients without AF recurrence had a shorter AF history.

Conclusions: AF ablation after PMVR is feasible and safe, but remains rarely performed. Early MR treatment by PMVR, followed by early AF ablation seems to be determinant for a good outcome. Further studies are needed to confirm these results.