Geis Nicolas A, Göbbel Anna, Kreusser Michael M, Täger Tobias, Katus Hugo A, Frey Norbert, Schlegel Philipp, Raake Philip W
Department of Internal Medicine III, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.
Life (Basel). 2022 Feb 25;12(3):344. doi: 10.3390/life12030344.
Transcatheter edge-to-edge repair (TEER) using the MitraClip™ device has been established as a suitable alternative to mitral valve surgery in patients with severe mitral regurgitation (MR) and high or prohibitive surgical risk. Only limited information regarding the impact of TEER on ventricular arrhythmias (VA) has been reported. The aim of the present study was to assess the impact of TEER using the MitraClip device on the burden of VA and ICD (Implantable Cardioverter Defibrillator) therapies. Among 600 MitraClip implantations performed in our clinic between September 2009 and October 2018, we identified 86 patients with successful TEER and an active implantable cardiac device (pacemaker, ICD, CRT-P/D (Cardiac Resynchronization Therapy-Pacemaker/Defibrillator)) eligible for retrospective VA analyses. These patients presented with mainly functional MR (81.4%) and severely reduced left ventricular ejection fraction (mean LVEF 22.1% ± 10.3%). The observation period comprised 456 ± 313 days before and 424 ± 287 days after TEER. The burden of ventricular arrhythmias (sustained ventricular tachycardia (sVT) and ventricular fibrillation (VF)) was significantly reduced after TEER (0.85 ± 3.47 vs. 0.43 ± 2.03 events per patient per month, = 0.01). Furthermore, the rate of ICD therapies (anti-tachycardia pacing (ATP) and ICD shock) decreased significantly after MitraClip implantation (1.0 ± 3.87 vs. 0.32 ± 1.41, = 0.014). However, reduction of VA burden did not result in improved two-year survival in this patient cohort with severely reduced LVEF. Mitral valve TEER using the MitraClip™ device was associated with a significant reduction of ventricular arrhythmias and ICD therapies.
使用MitraClip™装置进行经导管缘对缘修复（TEER）已被确立为严重二尖瓣反流（MR）且手术风险高或手术禁忌的患者二尖瓣手术的合适替代方案。关于TEER对室性心律失常（VA）影响的信息报道有限。本研究的目的是评估使用MitraClip装置进行TEER对VA负担和植入式心律转复除颤器（ICD）治疗的影响。在2009年9月至2018年10月期间于我们诊所进行的600例MitraClip植入手术中，我们确定了86例TEER成功且有活性植入式心脏装置（起搏器、ICD、心脏再同步治疗起搏器/除颤器（CRT-P/D））的患者，适合进行回顾性VA分析。这些患者主要表现为功能性MR（81.4%），左心室射血分数严重降低（平均LVEF 22.1%±10.3%）。观察期包括TEER前456±313天和TEER后424±287天。TEER后室性心律失常（持续性室性心动过速（sVT）和心室颤动（VF））的负担显著降低（每位患者每月0.85±3.47次事件 vs. 0.43±2.03次事件，P = 0.01）。此外，MitraClip植入后ICD治疗率（抗心动过速起搏（ATP）和ICD电击）显著降低（1.0±3.87次 vs. 0.32±1.41次，P = 0.014）。然而，在这个LVEF严重降低的患者队列中，VA负担的减轻并未导致两年生存率的提高。使用MitraClip™装置进行二尖瓣TEER与室性心律失常和ICD治疗的显著减少相关。
