Impact of Rhythm vs. Rate Control in Atrial Fibrillation on the Long-Term Outcome of Patients Undergoing Transcatheter Edge-to-Edge Mitral Valve Repair

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 growin...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Christian Waechter, Felix Ausbuettel, Georgios Chatzis, Juan Cheko, Dieter Fischer, Holger Nef, Sebastian Barth, Philipp Halbfass, Thomas Deneke, Sebastian Kerber, Jan Kikec, Hans-Helge Mueller, Dimitar Divchev, Bernhard Schieffer, Ulrich Luesebrink
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	MitraClip rhythm-control rate-control mitral regurgitation heart failure pharmacological rhythm control Medicine R
Acceso en línea:	https://doaj.org/article/2cb3503d16ed4f21acb11dbb36857d1a
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:2cb3503d16ed4f21acb11dbb36857d1a
record_format	dspace
spelling	oai:doaj.org-article:2cb3503d16ed4f21acb11dbb36857d1a2021-11-11T17:40:04ZImpact of Rhythm vs. Rate Control in Atrial Fibrillation on the Long-Term Outcome of Patients Undergoing Transcatheter Edge-to-Edge Mitral Valve Repair10.3390/jcm102150442077-0383https://doaj.org/article/2cb3503d16ed4f21acb11dbb36857d1a2021-10-01T00:00:00Zhttps://www.mdpi.com/2077-0383/10/21/5044https://doaj.org/toc/2077-0383Atrial 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), <i>p</i> = 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, <i>p</i> = 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), <i>p</i> = 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.Christian WaechterFelix AusbuettelGeorgios ChatzisJuan ChekoDieter FischerHolger NefSebastian BarthPhilipp HalbfassThomas DenekeSebastian KerberJan KikecHans-Helge MuellerDimitar DivchevBernhard SchiefferUlrich LuesebrinkMDPI AGarticleMitraCliprhythm-controlrate-controlmitral regurgitationheart failurepharmacological rhythm controlMedicineRENJournal of Clinical Medicine, Vol 10, Iss 5044, p 5044 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	MitraClip rhythm-control rate-control mitral regurgitation heart failure pharmacological rhythm control Medicine R
spellingShingle	MitraClip rhythm-control rate-control mitral regurgitation heart failure pharmacological rhythm control Medicine R Christian Waechter Felix Ausbuettel Georgios Chatzis Juan Cheko Dieter Fischer Holger Nef Sebastian Barth Philipp Halbfass Thomas Deneke Sebastian Kerber Jan Kikec Hans-Helge Mueller Dimitar Divchev Bernhard Schieffer Ulrich Luesebrink Impact of Rhythm vs. Rate Control in Atrial Fibrillation on the Long-Term Outcome of Patients Undergoing Transcatheter Edge-to-Edge Mitral Valve Repair
description	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), <i>p</i> = 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, <i>p</i> = 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), <i>p</i> = 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.
format	article
author	Christian Waechter Felix Ausbuettel Georgios Chatzis Juan Cheko Dieter Fischer Holger Nef Sebastian Barth Philipp Halbfass Thomas Deneke Sebastian Kerber Jan Kikec Hans-Helge Mueller Dimitar Divchev Bernhard Schieffer Ulrich Luesebrink
author_facet	Christian Waechter Felix Ausbuettel Georgios Chatzis Juan Cheko Dieter Fischer Holger Nef Sebastian Barth Philipp Halbfass Thomas Deneke Sebastian Kerber Jan Kikec Hans-Helge Mueller Dimitar Divchev Bernhard Schieffer Ulrich Luesebrink
author_sort	Christian Waechter
title	Impact of Rhythm vs. Rate Control in Atrial Fibrillation on the Long-Term Outcome of Patients Undergoing Transcatheter Edge-to-Edge Mitral Valve Repair
title_short	Impact of Rhythm vs. Rate Control in Atrial Fibrillation on the Long-Term Outcome of Patients Undergoing Transcatheter Edge-to-Edge Mitral Valve Repair
title_full	Impact of Rhythm vs. Rate Control in Atrial Fibrillation on the Long-Term Outcome of Patients Undergoing Transcatheter Edge-to-Edge Mitral Valve Repair
title_fullStr	Impact of Rhythm vs. Rate Control in Atrial Fibrillation on the Long-Term Outcome of Patients Undergoing Transcatheter Edge-to-Edge Mitral Valve Repair
title_full_unstemmed	Impact of Rhythm vs. Rate Control in Atrial Fibrillation on the Long-Term Outcome of Patients Undergoing Transcatheter Edge-to-Edge Mitral Valve Repair
title_sort	impact of rhythm vs. rate control in atrial fibrillation on the long-term outcome of patients undergoing transcatheter edge-to-edge mitral valve repair
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/2cb3503d16ed4f21acb11dbb36857d1a
work_keys_str_mv	AT christianwaechter impactofrhythmvsratecontrolinatrialfibrillationonthelongtermoutcomeofpatientsundergoingtranscatheteredgetoedgemitralvalverepair AT felixausbuettel impactofrhythmvsratecontrolinatrialfibrillationonthelongtermoutcomeofpatientsundergoingtranscatheteredgetoedgemitralvalverepair AT georgioschatzis impactofrhythmvsratecontrolinatrialfibrillationonthelongtermoutcomeofpatientsundergoingtranscatheteredgetoedgemitralvalverepair AT juancheko impactofrhythmvsratecontrolinatrialfibrillationonthelongtermoutcomeofpatientsundergoingtranscatheteredgetoedgemitralvalverepair AT dieterfischer impactofrhythmvsratecontrolinatrialfibrillationonthelongtermoutcomeofpatientsundergoingtranscatheteredgetoedgemitralvalverepair AT holgernef impactofrhythmvsratecontrolinatrialfibrillationonthelongtermoutcomeofpatientsundergoingtranscatheteredgetoedgemitralvalverepair AT sebastianbarth impactofrhythmvsratecontrolinatrialfibrillationonthelongtermoutcomeofpatientsundergoingtranscatheteredgetoedgemitralvalverepair AT philipphalbfass impactofrhythmvsratecontrolinatrialfibrillationonthelongtermoutcomeofpatientsundergoingtranscatheteredgetoedgemitralvalverepair AT thomasdeneke impactofrhythmvsratecontrolinatrialfibrillationonthelongtermoutcomeofpatientsundergoingtranscatheteredgetoedgemitralvalverepair AT sebastiankerber impactofrhythmvsratecontrolinatrialfibrillationonthelongtermoutcomeofpatientsundergoingtranscatheteredgetoedgemitralvalverepair AT jankikec impactofrhythmvsratecontrolinatrialfibrillationonthelongtermoutcomeofpatientsundergoingtranscatheteredgetoedgemitralvalverepair AT hanshelgemueller impactofrhythmvsratecontrolinatrialfibrillationonthelongtermoutcomeofpatientsundergoingtranscatheteredgetoedgemitralvalverepair AT dimitardivchev impactofrhythmvsratecontrolinatrialfibrillationonthelongtermoutcomeofpatientsundergoingtranscatheteredgetoedgemitralvalverepair AT bernhardschieffer impactofrhythmvsratecontrolinatrialfibrillationonthelongtermoutcomeofpatientsundergoingtranscatheteredgetoedgemitralvalverepair AT ulrichluesebrink impactofrhythmvsratecontrolinatrialfibrillationonthelongtermoutcomeofpatientsundergoingtranscatheteredgetoedgemitralvalverepair
_version_	1718431992715935744

Impact of Rhythm vs. Rate Control in Atrial Fibrillation on the Long-Term Outcome of Patients Undergoing Transcatheter Edge-to-Edge Mitral Valve Repair

Ejemplares similares