Waechter Christian, Ausbuettel Felix, Chatzis Georgios, Cheko Juan, Fischer Dieter, Nef Holger, Barth Sebastian, Halbfass Philipp, Deneke Thomas, Kerber Sebastian, Kikec Jan, Mueller Hans-Helge, Divchev Dimitar, Schieffer Bernhard, Luesebrink Ulrich
Department of Cardiology, University Hospital Marburg, Baldingerstraße, 35043 Marburg, Germany.
Department of Cardiology, Cardiovascular Center Rotenburg/Fulda, Heinz-Meise-Straße 100, 36199 Rotenburg/Fulda, Germany.
J Clin Med. 2021 Oct 28;10(21):5044. doi: 10.3390/jcm10215044.
Atrial fibrillation (AF) is a highly prevalent comorbidity in patients with severe mitral valve regurgitation (MR) undergoing transcatheter mitral valve repair (TMVR) and has been shown to significantly worsen their outcome. However, data on the impact of AF treatment strategy in this rapidly growing cohort of patients is unknown. In a multicenter, observational cohort study, 542 consecutive patients undergoing TMVR were enrolled, and subsequently, comprehensive survival analyses according to AF status and therapy were performed using propensity score matching and Cox regression. In the analyzed cohort, 373 (73.3%) of the TMVR patients had concomitant AF. Of these patients, 212 (59%) were on rate control therapy and 161 (41%) were on rhythm control therapy. At 3 years, significantly reduced cumulative survival was observed for patients on rhythm compared to patients on rate control (46.7% (75/161) vs. 56.5% (91/161), = 0.032). Amiodarone was used to a substantial extent for rhythm control and found to be an independent mortality predictor (Hazard Ratio 1.5, 95%CI 1.1-2.1, = 0.04). The adverse outcome of concomitant AF in TMVR patients was confirmed (AF: 47.3% (126/266) vs. non-AF: 58.3% (78/133), = 0.047). Rhythm control achieved almost exclusively pharmacologically is associated with an adverse outcome compared to the rate control of AF in TMVR. This raises awareness of the importance of AF and its treatment, as this seems to be a promising key point for improving the prognosis of TMVR patients.
心房颤动（AF）是接受经导管二尖瓣修复术（TMVR）的重度二尖瓣反流（MR）患者中一种高度普遍的合并症，并且已显示会显著恶化其预后。然而，关于AF治疗策略对这一快速增长的患者群体的影响的数据尚不清楚。在一项多中心观察性队列研究中，连续纳入了542例接受TMVR的患者，随后使用倾向评分匹配和Cox回归根据AF状态和治疗进行了全面的生存分析。在分析的队列中，373例（73.3%）TMVR患者合并AF。在这些患者中，212例（59%）接受心率控制治疗，161例（41%）接受节律控制治疗。在3年时，与接受心率控制的患者相比，接受节律控制的患者累积生存率显著降低（46.7%（75/161）对56.5%（91/161），P = 0.032）。胺碘酮在很大程度上用于节律控制，并且被发现是一个独立的死亡预测因素（风险比1.5，95%置信区间1.1 - 2.1，P = 0.04）。TMVR患者合并AF的不良结局得到证实（AF：47.3%（126/266）对非AF：58.3%（78/133），P = 0.047）。与TMVR中AF的心率控制相比，几乎完全通过药物实现的节律控制与不良结局相关。这提高了对AF及其治疗重要性的认识，因为这似乎是改善TMVR患者预后的一个有前景的关键点。
