Shah Siddharth, Raj Vijay, Abdelghany Mahmoud, Mena-Hurtado Carlos, Riaz Sana, Patel Siddharth, Wiener Howard, Chaudhuri Debanik
Department of Medicine, Division of Cardiology, State University of New York Upstate Medical University, 750 E Adams Street, Syracuse, NY, 13210, USA.
Pioneer Valley Cardiology, University of Massachusetts/ Baystate Medical Center, Mercy Medical Center, Springfield, MA, USA.
Heart Fail Rev. 2021 May;26(3):531-543. doi: 10.1007/s10741-020-10051-z. Epub 2020 Nov 10.
Atrial fibrillation (AF) is a common arrhythmia in patients with mitral regurgitation (MR) undergoing transcatheter mitral valve repair (TMVR). In this systematic review, we aimed to investigate the outcomes of TMVR using MitraClip in AF patients. We performed a systematic search using PubMed, SCOPUS, EMBASE, and Google Scholar, from inception to May 10, 2020, for studies that reported outcomes following MitraClip, in patients with AF versus without AF. Seven studies with a total of 7678 patients met the inclusion criteria. The risk of 1-year all-cause mortality following TMVR was higher in AF patients (RR 1.40, 95% CI 1.27-1.54, p ≤ 0.001). Similarly, the risk of heart failure hospitalization was higher in patients with AF (RR 1.17, 95% CI 1.06-1.30, p = 0.002) and the risk of bleeding was elevated in AF patients (RR 1.29, 95% CI 1.15-1.45, p ≤ 0.001). The risk of procedural failure, in-hospital mortality, cardiovascular mortality, and stroke was not significantly different between the two groups. The higher risk of all-cause mortality, HF hospitalization, and risk of bleeding in AF patients undergoing MitraClip warrants attention.
心房颤动（AF）是接受经导管二尖瓣修复术（TMVR）的二尖瓣反流（MR）患者中常见的心律失常。在这项系统评价中，我们旨在研究使用MitraClip治疗房颤患者的TMVR结果。我们使用PubMed、SCOPUS、EMBASE和谷歌学术进行了系统检索，检索时间从数据库建立至2020年5月10日，以查找报告房颤患者与非房颤患者使用MitraClip后的结果的研究。七项研究共纳入7678例患者，符合纳入标准。房颤患者TMVR后1年全因死亡风险更高（RR 1.40，95%CI 1.27-1.54，p≤0.001）。同样，房颤患者心力衰竭住院风险更高（RR 1.17，95%CI 1.06-1.30，p = 0.002），房颤患者出血风险升高（RR 1.29，95%CI 1.15-1.45，p≤0.001）。两组之间手术失败、住院死亡率、心血管死亡率和中风风险无显著差异。接受MitraClip治疗的房颤患者全因死亡、心力衰竭住院和出血风险较高，值得关注。
