Atrial Fibrillation and Clinical Outcomes Following Mitral Transcatheter Edge-to-Edge Repair According to Mitral Regurgitation Etiology

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BACKGROUND: The association between atrial fibrillation (AF) and prognosis after mitral transcatheter edge-to-edge repair (M-TEER) remains unclear. OBJECTIVES: The authors examined the association between AF and clinical outcomes after M-TEER according to the etiology of mitral regurgitation (MR). METHODS: A total of 3,764 patients were classified into degenerative mitral regurgitation (DMR), ventricular functional mitral regurgitation (VFMR), and atrial functional mitral regurgitation (AFMR). We further stratified the patients by the presence of AF. The primary outcome was all-cause mortality within 2 years. RESULTS: The prevalence of AF was 57.4% (n = 646 of 1,126) in DMR, 59.7% (n = 1,319 of 2,211) in VFMR, and 83.8% (n = 358 of 427) in AFMR. During 2-year follow-up (the median follow-up: 427 [IQR: 301-821] days), 660 of 3,764 patients (17.5%) died. The association between AF and all-cause mortality had a significant interaction with MR etiology (P for interaction <0.001). AF was associated with a higher risk of all-cause mortality in DMR (adjusted HR: 1.88; 95% CI: 1.17-3.02; P = 0.009), whereas this association was not significant in VFMR and AFMR. Among patients with VFMR, left atrial (LA) volume index modified the association between AF and all-cause mortality. AF was related to a higher risk of all-cause mortality in VFMR patients with lower LA volume index, whereas this association was attenuated in those with higher LA volume index. CONCLUSIONS: AF was associated with all-cause mortality after M-TEER in patients with DMR, but not in those with VFMR or AFMR. The prognostic effect of AF in patients undergoing M-TEER may be modulated by MR etiology and underlying LA remodeling.

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